Copyright Violations Form
* Required Field
Please provide the details about of the facility or business entity that is violating the Briggs copyright
Business/Facility Name:
*
Street/PO Box:
*
City/Town:
*
State:
*
select...
AL
AK
AZ
AR
CA
CO
CT
DE
FL
GA
HI
ID
IL
IN
LA
KS
KY
LA
ME
MD
MA
MI
MN
MS
MO
MT
NE
NV
NH
NJ
NM
NY
NC
ND
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VT
VA
WA
WV
WI
WY
Zip Code:
What is the name of the individual
making unauthorized copies:
*
Which forms are being copied. Please provide name of Form and Form Number
Form Name:
Form Number:
Form Name:
Form Number:
Form Name:
Form Number:
Form Name:
Form Number:
Form Name:
Form Number:
For how long has this been going on?
Year(s)
Month(s)
Week(s)
Day(s)
Please describe in your own words what is going on, how long it has been going on, and how you learned about this?
Please provide the following information
Your Name:
*
Your Title/Position:
Your Address:
Street:
City/Town:
State:
select...
AL
AK
AZ
AR
CA
CO
CT
DE
FL
GA
HI
ID
IL
IN
LA
KS
KY
LA
ME
Phone Number:
E-mail address:
Thank you, for reporting this violation.
May we use your name in following up with this report?
Yes
No