The following is a legal document subject to possible penalties under federal, state, and local laws. Any attempt to mislead, misrepresent, falsify this document, or abuse this process may result in legal action including but not limited to criminal proceedings.

List the name of the person filling out this form, regardless of whether you are the complainant or not.

List the name of the person making the accusation here.

If complainant is represented by counsel, list that here. This section is not required if complainant is not represented by counsel.

Contact information for law firm if using legal representation for this matter, otherwise please list your contact information.

If this is in reference to a specific video please include that information below. This section is not required if this is not in reference to a specific video.

Please state the nature of the legal complaint, including dates, times, location, and names with contact info of all involved parties.

I attest under penalty of perjury that the information in this form is complete and accurate. Furthermore, I confirm that I am the owner of any material in question, or I am an agent authorized by the owner to act on their behalf. I understand that any abuse of this process is grounds for legal action against me, including but not limited to criminal proceedings.