Counter Notification Form (1) Your Name: (2) Your Address: (3) Your Telephone #: (4) Your E-mail Address: (5) Identity of the material that has been removed or to which access has been disabled: (6) Location of the material that was removed or to which access has been disabled before it was taken down or disabled: By typing or otherwise writing my name here, I, ________, do represent and warrant, under the penalty of perjury, that I believe, in good faith, that the material I have identified above was only removed or disabled as the result of a mistake or misidentification. My submission of this form signifies my consent to the jurisdiction of the Federal District Court for the judicial district in which the address I have furnished above is located, or, if the address I provided above is outside the United States, my consent to the jurisdiction of the Federal District Court for San Diego County, California. I agree to accept process from the person who provided notification of the alleged copyright violation(s), which is the subject of this counter notification form, or from an agent of such person. I understand that by typing or otherwise writing my name above I am providing an electronic signature that is in all ways equivalent to providing a physical signature on a tangible legal document.
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