Joe Skinner [your nick]
Joe P. Citizen [your name]
123 Fourth Street, Wherever 9999 [your home address]
xx/xx/2009 <---- [the date]
DMCA Removal Notice:
Please accept this as a request to remove the following unauthorized versions my intellectual property in keeping with the Digital Millennium Copyright Act (DMCA) which can be found at http://www.copyright.gov/legislation/dmca.pdf
1) I am the owner of the intellectual property whose rights are being infringed and I am authorized to act on my own behalf.
2) My contact information and electronic signature are below.
3) The infringing materials can be found at the following location(s):
FILL IN THE BLANKS
4) The materials are my exclusive intellectual property and may not be redistributed without my permission.
5) I have a good faith belief that "use of the material in the manner complained of is not authorized by the copyright owner, its agents, or the law."
6) The information above is accurate to the best of my knowledge under penalty of perjury.
7) My electronic signature is below.
Please do not hesitate to contact me if you need any further information. Thank you for your cooperation.