View a sample USA PDF Notice of Harassment
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USA PDF Notice of Harassment

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  • This form also known as: notice of harassment form, free bullying form, school bullying kit, legal notice of bullying, bullying prevention kit, student harassment form, legal notice of harassment, bullying legal document

Documatica Notice of Harassment

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PDF Notice of Harassment Form

A Notice of Harassment is used by a victim of bullying or other harassment (after appropriate records of the bullying have been made) to notify the bully's parents, teachers, and/or principal of the nature of events that are occurring. The recipient will then be obligated to address the situation or face additional liability for the bully's actions. The Notice of Harassment form is available free of charge, for all common law jurisdictions in the United States and Canada.

More about Notice of Harassment legal forms.

  • Proceed through this form, providing as much information as possible.
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  • When you are done, click on 'Build Document' at the bottom.

Before making a Notice of Harassment, ensure that you have read the instructions and have records of each bullying incident handy (including dates, places, and events). Due to the highly specific nature of this form, it is very computationally intensive. Please be patient as we are processing your responses.

Governing Jurisdiction:

Where will this notice be used?

Select a province or territory:

Select a state:

Create Notices For:

Principal
 Yes No

Teacher
 Yes No

Bully's Parent(s)
 Yes No

Victim Information:

Victim's Full Name:

How many legal guardians does the Victim have?

First Guardian's Name:

Second Guardian's Name:

Correspondence Address:

City:

Select a country:

Select a province or territory:

Select a state:

Principal's Information:

Name:

School:

City:

Select a country:

Select a province or territory:

Select a state:

Teacher's Information:

Name:

School:

City:

Select a country:

Select a province or territory:

Select a state:

Bully's Parent Information:

How many legal guardians does the bully have?

First Guardian's Name:

Second Guardian's Name:

Correspondence Address:

City:

Select a country:

Select a province or territory:

Select a state:

Bully's Information:

Name:

Address:

City:

Select a country:

Select a province or territory:

Select a state:

Descriptions of Events:
Please describe each bullying event in 1-3 complete sentences.

Assault/Battery:

Assault/Battery:
An imminent physical threat is a threat that could have led to immediate physical harm to the victim. An example would be holding a knife to the Victim's throat, and then pulling it away. Statements like "I will slit your throat tomorrow!" would be considered a non-imminent physical threat.
Did the Bully cause actual physical harm?
 Yes No

How many times?

Physical Harm Event 1:

Date (e.g. March 12th, 2006):

Place:

Provide a brief description of the events:


Physical Harm Event 2:

Date:

Place:

Provide a brief description of the events:


Physical Harm Event 3:

Date:

Place:

Provide a brief description of the events:


Physical Harm Event 4:

Date:

Place:

Provide a brief description of the events:


Physical Harm Event 5:

Date:

Place:

Provide a brief description of the events:


Physical Harm Event 6:

Date:

Place:

Provide a brief description of the events:


Physical Harm Event 7:

Date:

Place:

Provide a brief description of the events:


Physical Harm Event 8:

Date:

Place:

Provide a brief description of the events:


Physical Harm Event 9:

Date:

Place:

Provide a brief description of the events:


Physical Harm Event 10:

Date:

Place:

Provide a brief description of the events:


Did the Bully present an imminent physical threat?
 Yes No

How many times?

Imminent Physical Threat Event 1:

Date (e.g. March 12th, 2006):

Place:

Provide a brief description of the events:


Imminent Physical Threat Event 2:

Date:

Place:

Provide a brief description of the events:


Imminent Physical Threat Event 3:

Date:

Place:

Provide a brief description of the events:


Imminent Physical Threat Event 4:

Date:

Place:

Provide a brief description of the events:


Imminent Physical Threat Event 5:

Date:

Place:

Provide a brief description of the events:


Imminent Physical Threat Event 6:

Date:

Place:

Provide a brief description of the events:


Imminent Physical Threat Event 7:

Date:

Place:

Provide a brief description of the events:


Imminent Physical Threat Event 8:

Date:

Place:

Provide a brief description of the events:


Imminent Physical Threat Event 9:

Date:

Place:

Provide a brief description of the events:


Imminent Physical Threat Event 10:

Date:

Place:

Provide a brief description of the events:


Threats and Intimidation:

Has the Bully made non-imminent physical threats?
 Yes No

How many times?

Non-Imminent Physical Threat Event 1:

Date (e.g. March 12th, 2006):

Place:

Provide a brief description of the events:


Non-Imminent Physical Threat Event 2:

Date:

Place:

Provide a brief description of the events:


Non-Imminent Physical Threat Event 3:

Date:

Place:

Provide a brief description of the events:


Non-Imminent Physical Threat Event 4:

Date:

Place:

Provide a brief description of the events:


Non-Imminent Physical Threat Event 5:

Date:

Place:

Provide a brief description of the events:


Non-Imminent Physical Threat Event 6:

Date:

Place:

Provide a brief description of the events:


Non-Imminent Physical Threat Event 7:

Date:

Place:

Provide a brief description of the events:


Non-Imminent Physical Threat Event 8:

Date:

Place:

Provide a brief description of the events:


Non-Imminent Physical Threat Event 9:

Date:

Place:

Provide a brief description of the events:


Non-Imminent Physical Threat Event 10:

Date:

Place:

Provide a brief description of the events:


Has the Bully threatened the Victim's family/friends/pets?
 Yes No

How many times?

Loved One Threat Event 1:

Date (e.g. March 12th, 2006):

Place:

Provide a brief description of the events:


Loved One Threat Event 2:

Date:

Place:

Provide a brief description of the events:


Loved One Threat Event 3:

Date:

Place:

Provide a brief description of the events:


Loved One Threat Event 4:

Date:

Place:

Provide a brief description of the events:


Loved One Threat Event 5:

Date:

Place:

Provide a brief description of the events:


Loved One Threat Event 6:

Date:

Place:

Provide a brief description of the events:


Loved One Threat Event 7:

Date:

Place:

Provide a brief description of the events:


Loved One Threat Event 8:

Date:

Place:

Provide a brief description of the events:


Loved One Threat Event 9:

Date:

Place:

Provide a brief description of the events:


Loved One Threat Event 10:

Date:

Place:

Provide a brief description of the events:


Has the Bully threatened the Victim's personal property?
 Yes No

How many times?

Property Threat Event 1:

Date (e.g. March 12th, 2006):

Place:

Provide a brief description of the events:


Property Threat Event 2:

Date:

Place:

Provide a brief description of the events:


Property Threat Event 3:

Date:

Place:

Provide a brief description of the events:


Property Threat Event 4:

Date:

Place:

Provide a brief description of the events:


Property Threat Event 5:

Date:

Place:

Provide a brief description of the events:


Property Threat Event 6:

Date:

Place:

Provide a brief description of the events:


Property Threat Event 7:

Date:

Place:

Provide a brief description of the events:


Property Threat Event 8:

Date:

Place:

Provide a brief description of the events:


Property Threat Event 9:

Date:

Place:

Provide a brief description of the events:


Property Threat Event 10:

Date:

Place:

Provide a brief description of the events:


Has the Bully threatened the Victim in other ways?
 Yes No

How many times?

Other Threat Event 1:

Date (e.g. March 12th, 2006):

Place:

Provide a brief description of the events:


Other Threat Event 2:

Date:

Place:

Provide a brief description of the events:


Other Threat Event 3:

Date:

Place:

Provide a brief description of the events:


Other Threat Event 4:

Date:

Place:

Provide a brief description of the events:


Other Threat Event 5:

Date:

Place:

Provide a brief description of the events:


Other Threat Event 6:

Date:

Place:

Provide a brief description of the events:


Other Threat Event 7:

Date:

Place:

Provide a brief description of the events:


Other Threat Event 8:

Date:

Place:

Provide a brief description of the events:


Other Threat Event 9:

Date:

Place:

Provide a brief description of the events:


Other Threat Event 10:

Date:

Place:

Provide a brief description of the events:


Extortion:

Extortion:
Extortion is defined as the act of taking money or personal property from someone, using threats or physical force. It is also called blackmail in common language.
Has the Bully extorted the Victim?
 Yes No

How many times?

Extortion Event 1:

Date (e.g. March 12th, 2006):

Place:

Provide a brief description of the events:


Extortion Event 2:

Date:

Place:

Provide a brief description of the events:


Extortion Event 3:

Date:

Place:

Provide a brief description of the events:


Extortion Event 4:

Date:

Place:

Provide a brief description of the events:


Extortion Event 5:

Date:

Place:

Provide a brief description of the events:


Extortion Event 6:

Date:

Place:

Provide a brief description of the events:


Extortion Event 7:

Date:

Place:

Provide a brief description of the events:


Extortion Event 8:

Date:

Place:

Provide a brief description of the events:


Extortion Event 9:

Date:

Place:

Provide a brief description of the events:


Extortion Event 10:

Date:

Place:

Provide a brief description of the events:


Theft:

Has the Bully stolen the Victim's personal property?
 Yes No

How many times?

Theft Event 1:

Date (e.g. March 12th, 2006):

Place:

Provide a brief description of the events:


Theft Event 2:

Date:

Place:

Provide a brief description of the events:


Theft Event 3:

Date:

Place:

Provide a brief description of the events:


Theft Event 4:

Date:

Place:

Provide a brief description of the events:


Theft Event 5:

Date:

Place:

Provide a brief description of the events:


Theft Event 6:

Date:

Place:

Provide a brief description of the events:


Theft Event 7:

Date:

Place:

Provide a brief description of the events:


Theft Event 8:

Date:

Place:

Provide a brief description of the events:


Theft Event 9:

Date:

Place:

Provide a brief description of the events:


Theft Event 10:

Date:

Place:

Provide a brief description of the events:


Harassment/Sexual Harassment:

Has the Bully humiliated the Victim in front of peers or teachers?
 Yes No

How many times?

Humiliation Event 1:

Date (e.g. March 12th, 2006):

Place:

Provide a brief description of the events:


Humiliation Event 2:

Date:

Place:

Provide a brief description of the events:


Humiliation Event 3:

Date:

Place:

Provide a brief description of the events:


Humiliation Event 4:

Date:

Place:

Provide a brief description of the events:


Humiliation Event 5:

Date:

Place:

Provide a brief description of the events:


Humiliation Event 6:

Date:

Place:

Provide a brief description of the events:


Humiliation Event 7:

Date:

Place:

Provide a brief description of the events:


Humiliation Event 8:

Date:

Place:

Provide a brief description of the events:


Humiliation Event 9:

Date:

Place:

Provide a brief description of the events:


Humiliation Event 10:

Date:

Place:

Provide a brief description of the events:


Has the Bully teased the Victim or called them names (non-sexual)?
 Yes No

How many times?

Non-Sexual Teasing Event 1:

Date (e.g. March 12th, 2006):

Place:

Provide a brief description of the events:


Non-Sexual Teasing Event 2:

Date:

Place:

Provide a brief description of the events:


Non-Sexual Teasing Event 3:

Date:

Place:

Provide a brief description of the events:


Non-Sexual Teasing Event 4:

Date:

Place:

Provide a brief description of the events:


Non-Sexual Teasing Event 5:

Date:

Place:

Provide a brief description of the events:


Non-Sexual Teasing Event 6:

Date:

Place:

Provide a brief description of the events:


Non-Sexual Teasing Event 7:

Date:

Place:

Provide a brief description of the events:


Non-Sexual Teasing Event 8:

Date:

Place:

Provide a brief description of the events:


Non-Sexual Teasing Event 9:

Date:

Place:

Provide a brief description of the events:


Non-Sexual Teasing Event 10:

Date:

Place:

Provide a brief description of the events:


Has the Bully teased the Victim or called them names (sexual)?
 Yes No

How many times?

Sexual Teasing Event 1:

Date (e.g. March 12th, 2006):

Place:

Provide a brief description of the events:


Sexual Teasing Event 2:

Date:

Place:

Provide a brief description of the events:


Sexual Teasing Event 3:

Date:

Place:

Provide a brief description of the events:


Sexual Teasing Event 4:

Date:

Place:

Provide a brief description of the events:


Sexual Teasing Event 5:

Date:

Place:

Provide a brief description of the events:


Sexual Teasing Event 6:

Date:

Place:

Provide a brief description of the events:


Sexual Teasing Event 7:

Date:

Place:

Provide a brief description of the events:


Sexual Teasing Event 8:

Date:

Place:

Provide a brief description of the events:


Sexual Teasing Event 9:

Date:

Place:

Provide a brief description of the events:


Sexual Teasing Event 10:

Date:

Place:

Provide a brief description of the events:


Has the Bully harassed the Victim by phone?
 Yes No

How many times?

Telephone Harassment Event 1:

Date (e.g. March 12th, 2006):

Place:

Provide a brief description of the events:


Telephone Harassment Event 2:

Date:

Place:

Provide a brief description of the events:


Telephone Harassment Event 3:

Date:

Place:

Provide a brief description of the events:


Telephone Harassment Event 4:

Date:

Place:

Provide a brief description of the events:


Telephone Harassment Event 5:

Date:

Place:

Provide a brief description of the events:


Telephone Harassment Event 6:

Date:

Place:

Provide a brief description of the events:


Telephone Harassment Event 7:

Date:

Place:

Provide a brief description of the events:


Telephone Harassment Event 8:

Date:

Place:

Provide a brief description of the events:


Telephone Harassment Event 9:

Date:

Place:

Provide a brief description of the events:


Telephone Harassment Event 10:

Date:

Place:

Provide a brief description of the events:


Has the Bully harassed the Victim using notes/letters?
 Yes No

How many times?

Written Harassment Event 1:

Date (e.g. March 12th, 2006):

Place:

Provide a brief description of the events:


Written Harassment Event 2:

Date:

Place:

Provide a brief description of the events:


Written Harassment Event 3:

Date:

Place:

Provide a brief description of the events:


Written Harassment Event 4:

Date:

Place:

Provide a brief description of the events:


Written Harassment Event 5:

Date:

Place:

Provide a brief description of the events:


Written Harassment Event 6:

Date:

Place:

Provide a brief description of the events:


Written Harassment Event 7:

Date:

Place:

Provide a brief description of the events:


Written Harassment Event 8:

Date:

Place:

Provide a brief description of the events:


Written Harassment Event 9:

Date:

Place:

Provide a brief description of the events:


Written Harassment Event 10:

Date:

Place:

Provide a brief description of the events:


Has the Bully harassed the Victim electronically (e.g. e-mail, instant messaging, etc)?
 Yes No

How many times?

Electronic Harassment Event 1:

Date (e.g. March 12th, 2006):

Place:

Provide a brief description of the events:


Electronic Harassment Event 2:

Date:

Place:

Provide a brief description of the events:


Electronic Harassment Event 3:

Date:

Place:

Provide a brief description of the events:


Electronic Harassment Event 4:

Date:

Place:

Provide a brief description of the events:


Electronic Harassment Event 5:

Date:

Place:

Provide a brief description of the events:


Electronic Harassment Event 6:

Date:

Place:

Provide a brief description of the events:


Electronic Harassment Event 7:

Date:

Place:

Provide a brief description of the events:


Electronic Harassment Event 8:

Date:

Place:

Provide a brief description of the events:


Electronic Harassment Event 9:

Date:

Place:

Provide a brief description of the events:


Electronic Harassment Event 10:

Date:

Place:

Provide a brief description of the events:


Has the Bully harassed the Victim by abusing his/her authority in a club or athletic group?
 Yes No

How many times?

Abuse of Authority Event 1:

Date (e.g. March 12th, 2006):

Place:

Provide a brief description of the events:


Abuse of Authority Event 2:

Date:

Place:

Provide a brief description of the events:


Abuse of Authority Event 3:

Date:

Place:

Provide a brief description of the events:


Abuse of Authority Event 4:

Date:

Place:

Provide a brief description of the events:


Abuse of Authority Event 5:

Date:

Place:

Provide a brief description of the events:


Abuse of Authority Event 6:

Date:

Place:

Provide a brief description of the events:


Abuse of Authority Event 7:

Date:

Place:

Provide a brief description of the events:


Abuse of Authority Event 8:

Date:

Place:

Provide a brief description of the events:


Abuse of Authority Event 9:

Date:

Place:

Provide a brief description of the events:


Abuse of Authority Event 10:

Date:

Place:

Provide a brief description of the events:


Has the Bully made unwelcome advances/touching?
 Yes No

How many times?

Unwelcome Advances Event 1:

Date (e.g. March 12th, 2006):

Place:

Provide a brief description of the events:


Unwelcome Advances Event 2:

Date:

Place:

Provide a brief description of the events:


Unwelcome Advances Event 3:

Date:

Place:

Provide a brief description of the events:


Unwelcome Advances Event 4:

Date:

Place:

Provide a brief description of the events:


Unwelcome Advances Event 5:

Date:

Place:

Provide a brief description of the events:


Unwelcome Advances Event 6:

Date:

Place:

Provide a brief description of the events:


Unwelcome Advances Event 7:

Date:

Place:

Provide a brief description of the events:


Unwelcome Advances Event 8:

Date:

Place:

Provide a brief description of the events:


Unwelcome Advances Event 9:

Date:

Place:

Provide a brief description of the events:


Unwelcome Advances Event 10:

Date:

Place:

Provide a brief description of the events:


Mischief:

Has the Bully performed mischief or damaged the Victim's property?
 Yes No

How many times?

Mischief Event 1:

Date (e.g. March 12th, 2006):

Place:

Provide a brief description of the events:


Mischief Event 2:

Date:

Place:

Provide a brief description of the events:


Mischief Event 3:

Date:

Place:

Provide a brief description of the events:


Mischief Event 4:

Date:

Place:

Provide a brief description of the events:


Mischief Event 5:

Date:

Place:

Provide a brief description of the events:


Mischief Event 6:

Date:

Place:

Provide a brief description of the events:


Mischief Event 7:

Date:

Place:

Provide a brief description of the events:


Mischief Event 8:

Date:

Place:

Provide a brief description of the events:


Mischief Event 9:

Date:

Place:

Provide a brief description of the events:


Mischief Event 10:

Date:

Place:

Provide a brief description of the events:


Discrimination:

Has the Bully discriminated against the Victim on the basis of physical or mental disability?
 Yes No

How many times?

Physical/Mental Discrimination Event 1:

Date (e.g. March 12th, 2006):

Place:

Provide a brief description of the events:


Physical/Mental Discrimination Event 2:

Date:

Place:

Provide a brief description of the events:


Physical/Mental Discrimination Event 3:

Date:

Place:

Provide a brief description of the events:


Physical/Mental Discrimination Event 4:

Date:

Place:

Provide a brief description of the events:


Physical/Mental Discrimination Event 5:

Date:

Place:

Provide a brief description of the events:


Physical/Mental Discrimination Event 6:

Date:

Place:

Provide a brief description of the events:


Physical/Mental Discrimination Event 7:

Date:

Place:

Provide a brief description of the events:


Physical/Mental Discrimination Event 8:

Date:

Place:

Provide a brief description of the events:


Physical/Mental Discrimination Event 9:

Date:

Place:

Provide a brief description of the events:


Physical/Mental Discrimination Event 10:

Date:

Place:

Provide a brief description of the events:


Has the Bully discriminated against the Victim on the basis of race?
 Yes No

How many times?

Racial Discrimination Event 1:

Date (e.g. March 12th, 2006):

Place:

Provide a brief description of the events:


Racial Discrimination Event 2:

Date:

Place:

Provide a brief description of the events:


Racial Discrimination Event 3:

Date:

Place:

Provide a brief description of the events:


Racial Discrimination Event 4:

Date:

Place:

Provide a brief description of the events:


Racial Discrimination Event 5:

Date:

Place:

Provide a brief description of the events:


Racial Discrimination Event 6:

Date:

Place:

Provide a brief description of the events:


Racial Discrimination Event 7:

Date:

Place:

Provide a brief description of the events:


Racial Discrimination Event 8:

Date:

Place:

Provide a brief description of the events:


Racial Discrimination Event 9:

Date:

Place:

Provide a brief description of the events:


Racial Discrimination Event 10:

Date:

Place:

Provide a brief description of the events:


Has the Bully discriminated against the Victim on the basis of sexuality/sexual orientation?
 Yes No

How many times?

Sexual Discrimination Event 1:

Date (e.g. March 12th, 2006):

Place:

Provide a brief description of the events:


Sexual Discrimination Event 2:

Date:

Place:

Provide a brief description of the events:


Sexual Discrimination Event 3:

Date:

Place:

Provide a brief description of the events:


Sexual Discrimination Event 4:

Date:

Place:

Provide a brief description of the events:


Sexual Discrimination Event 5:

Date:

Place:

Provide a brief description of the events:


Sexual Discrimination Event 6:

Date:

Place:

Provide a brief description of the events:


Sexual Discrimination Event 7:

Date:

Place:

Provide a brief description of the events:


Sexual Discrimination Event 8:

Date:

Place:

Provide a brief description of the events:


Sexual Discrimination Event 9:

Date:

Place:

Provide a brief description of the events:


Sexual Discrimination Event 10:

Date:

Place:

Provide a brief description of the events:


Has the Bully discriminated against the Victim on the basis of religion?
 Yes No

How many times?

Religious Discrimination Event 1:

Date (e.g. March 12th, 2006):

Place:

Provide a brief description of the events:


Religious Discrimination Event 2:

Date:

Place:

Provide a brief description of the events:


Religious Discrimination Event 3:

Date:

Place:

Provide a brief description of the events:


Religious Discrimination Event 4:

Date:

Place:

Provide a brief description of the events:


Religious Discrimination Event 5:

Date:

Place:

Provide a brief description of the events:


Religious Discrimination Event 6:

Date:

Place:

Provide a brief description of the events:


Religious Discrimination Event 7:

Date:

Place:

Provide a brief description of the events:


Religious Discrimination Event 8:

Date:

Place:

Provide a brief description of the events:


Religious Discrimination Event 9:

Date:

Place:

Provide a brief description of the events:


Religious Discrimination Event 10:

Date:

Place:

Provide a brief description of the events:


Slander/Libel:

Slander/Libel:
Slander and libel consist of making untrue statements that damage the reputation of the Victim.
Has the Bully created slanderous graffiti against the Victim?
 Yes No

How many times?

Graffiti Event 1:

Date (e.g. March 12th, 2006):

Place:

Provide a brief description of the events:


Graffiti Event 2:

Date:

Place:

Provide a brief description of the events:


Graffiti Event 3:

Date:

Place:

Provide a brief description of the events:


Graffiti Event 4:

Date:

Place:

Provide a brief description of the events:


Graffiti Event 5:

Date:

Place:

Provide a brief description of the events:


Graffiti Event 6:

Date:

Place:

Provide a brief description of the events:


Graffiti Event 7:

Date:

Place:

Provide a brief description of the events:


Graffiti Event 8:

Date:

Place:

Provide a brief description of the events:


Graffiti Event 9:

Date:

Place:

Provide a brief description of the events:


Graffiti Event 10:

Date:

Place:

Provide a brief description of the events:


Has the Bully created slanderous notes/writings against the Victim?
 Yes No

How many times?

Written Libel Event 1:

Date (e.g. March 12th, 2006):

Place:

Provide a brief description of the events:


Written Libel Event 2:

Date:

Place:

Provide a brief description of the events:


Written Libel Event 3:

Date:

Place:

Provide a brief description of the events:


Written Libel Event 4:

Date:

Place:

Provide a brief description of the events:


Written Libel Event 5:

Date:

Place:

Provide a brief description of the events:


Written Libel Event 6:

Date:

Place:

Provide a brief description of the events:


Written Libel Event 7:

Date:

Place:

Provide a brief description of the events:


Written Libel Event 8:

Date:

Place:

Provide a brief description of the events:


Written Libel Event 9:

Date:

Place:

Provide a brief description of the events:


Written Libel Event 10:

Date:

Place:

Provide a brief description of the events:


Has the Bully slandered the Victim electronically (e-mail, instant messaging, etc)?
 Yes No

How many times?

Electronic Libel Event 1:

Date (e.g. March 12th, 2006):

Place:

Provide a brief description of the events:


Electronic Libel Event 2:

Date:

Place:

Provide a brief description of the events:


Electronic Libel Event 3:

Date:

Place:

Provide a brief description of the events:


Electronic Libel Event 4:

Date:

Place:

Provide a brief description of the events:


Electronic Libel Event 5:

Date:

Place:

Provide a brief description of the events:


Electronic Libel Event 6:

Date:

Place:

Provide a brief description of the events:


Electronic Libel Event 7:

Date:

Place:

Provide a brief description of the events:


Electronic Libel Event 8:

Date:

Place:

Provide a brief description of the events:


Electronic Libel Event 9:

Date:

Place:

Provide a brief description of the events:


Electronic Libel Event 10:

Date:

Place:

Provide a brief description of the events:


Has the Bully spread false, negative rumors about the Victim?
 Yes No

How many times?

Slander Event 1:

Date (e.g. March 12th, 2006):

Place:

Provide a brief description of the events:


Slander Event 2:

Date:

Place:

Provide a brief description of the events:


Slander Event 3:

Date:

Place:

Provide a brief description of the events:


Slander Event 4:

Date:

Place:

Provide a brief description of the events:


Slander Event 5:

Date:

Place:

Provide a brief description of the events:


Slander Event 6:

Date:

Place:

Provide a brief description of the events:


Slander Event 7:

Date:

Place:

Provide a brief description of the events:


Slander Event 8:

Date:

Place:

Provide a brief description of the events:


Slander Event 9:

Date:

Place:

Provide a brief description of the events:


Slander Event 10:

Date:

Place:

Provide a brief description of the events:


Signatures:

Signatures:
We recommend signing this notice in front of a notary public, or alternately a witness. Ideally, the witness should be an independent third party who is not related to you. In addition, the Victim will need to sign the notice, affirming that he or she is telling the truth.
This notice will be signed in front of a:

Date of Delivery:

Day (e.g. 5):

Month (e.g. September):

Year (e.g. 2006):