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Your full legal name (signature) Are you the rights holder? Yes — I am the copyright owner No — I am authorized to act for the owner Describe the copyrighted work Good-faith statement I have a good-faith belief that the use of the material in the manner complained of is not authorized by the copyright owner, its agent, or the law. Perjury statement I swear, under penalty of perjury, that the information in this notification is accurate and that I am the copyright owner or am authorized to act on behalf of the owner.