LexisNexis

Important Notice to Freelance Authors
Sample Request

July 10, 2001

LexisNexis
Attn: Freelance Coordinator
B4/F5/S83
9443 Springboro Pike
Miamisburg, OH 45342

RE: Notice of Copyright

Dear Sir/Madam:

1. Reference is made to the following article(s) appearing in the LexisNexis online service:

Title: A Town Square for our Main Street
Author: John Doe
Publication: XYZ123 News
Published: May 6, 2000
LN Database: ALLNWS

2. My current contact information is as follows:

John Doe
1111 Main Street
Any Town, AS 00000
Tel: (000) 000-0000
Fax: (000) 000-0001
jdoe@XXXXXX.com

I will immediately notify LexisNexis of any changes to my contact information.

3. I own the copyright on the above-referenced article(s), and (you must choose one of the following):

_____ I have registered this copyright with the United States Copyright Office on May 7, 2000, bearing registration number 000000, a copy of the registration statement is attached; or 

____ I have not registered this copyright with the United States Copyright Office.

4. I believe in good faith that the electronic distribution of the article(s) through the LexisNexis online service has not been authorized by me, by any of my licensees or agents or by applicable law.


Further Affiant sayeth naught.


STATE OF _________________
SS:
COUNTY OF _______________
Before me, a Notary Public in and for said state personally appeared the above named John Doe who being duly sworn (or affirmed) deposes and says under penalty of perjury that the foregoing statements 1-4 are true and correct.

________________________
John Doe

Sworn to (or affirmed) before me and signed in my presence this ______ day of ___________, 20___,

________________________
Notary Public

My commission expires: