DATE: _______________________

TO: My Black Hair TV

19** Laveer Street

Philadelphia, Pennsylvania 19141

Attn: Copyright Agent


  1. I am the owner, or an agent authorized to act on behalf of the owner, which owner’s name is

________________________________ (“IP Owner”), of the following copyrighted work.

Identify, in sufficient detail, the copyrighted work that you claim has been infringed upon, including providing any registration number or other identification, if available. Attach applicable documents, if any.

  1. I have a good faith belief that the content described below and being made available to end users of the Company’s products is not authorized by the IP owner, its agent, or the law, and therefore infringes the IP Owner’s rights:

Identify the content that you claim is infringing the copyright identified above.

Where does the alleged infringing material appear? Please provide sufficient information to help us locate the content you are reporting.

Please describe how the content infringes your or the IP owner’s rights (this question may assist us with processing your claim and eliminate the potential need for follow-up questions should your notice be unclear).

Identify, if possible, information sufficient to permit the Company to notify the channel application developer and/or service provider of the allegedly infringing content.

  1. I acknowledge that this Notice, including my contact information, may be provided to the channel application developer and/or service provider associated with the alleged infringing content.
  2. I may be contacted as follows:

My Name:

My Telephone:

Company or Other IP Owner (if different from me):


Check one of the boxes below.

The information I have provided in this statement is accurate.

I agree: □

I disagree: □

Electronic or Physical Signature: