Certification Form



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Please fill out the following form if you intend to convert copyright material for home use.

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I _________________ own the video tape entitled: ____________________.

This videotape is recorded in a foreign Video standard that I can not view on my TV/VCR. The standards conversion that I requested will be for home use only.



Your signature ________________________

Date________________________________

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Last Updated October 20, 2004 by Robert Rice