NOTICE OF TERMINATION OF RIGHTS GRANTED TO COPYRIGHT
To: _____________________________________________ (Grantee) of _________________________________________________ (Address) Re: Withdrawal of rights granted to copyright.
You are hereby notified that effective __________________ (Date), the following rights granted to you under copyright number __________________ have been revoked by the undersigned copyright owner. The rights given to you were as follows: ______________________________________________________________________ (State Rights). The previously mentioned rights were granted on _________________ (Date) by the copyright owner.
______________________________ Signature
___________________ Date