Sample Form | Example DMCA Counter-Notice Form

Sample/Example DMCA Counter-Notice Form

Date:____________________

[Service Provider Name]
[Service Provider Address]

To Whom It May Concern,

I am writing to you to avail myself of my rights under the Digital Millennium Copyright Act (DMCA). You recently provided me with a copy of Notice of Infringement from [name the party who submitted the Notice of Infringement]. This letter is a Counter-Notification as authorized in § 512(g) of the U.S. Copyright Law. I have a good faith belief that the material that was removed or disabled as a result of the Notice of Infringement as a result of mistake or misidentification of the material. I therefore request that the material be replaced and/or no longer disabled.

You are registered with the U.S. Copyright Office as the Designated Service Provider Agent to receive notifications of alleged Copyright infringement with respect to users of the Service for which you are the Designated Agent.

1. The material in question formerly appeared at the website address: [provide the full website address, and a link to the page on which the material appears].

2. My contact information is as follows: [provide your name, address, telephone number, and email address].

3. I consent to the jurisdiction of the Federal District Court for the judicial district in which my address is located (solely for the purposes of the resolution of this dispute), and I agree to accept service of process from the person who provided the Notice of Infringement.

4. I have a good faith belief that the material removed or disabled following the Notice of Infringement was removed or disabled because of mistake or misidentification of the material. I therefore request that the material be replaced and/or no longer disabled.

I declare under the perjury laws of the United States of America that this notification is true and correct.

[your signature]
[your name]

Or: Sample Example DMCA Notification of Infringement - DMCA Takedown Notice Form

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