Enter your legal First and Last name:
Current email address you have access to:
By signing the Electronic Signature box below and submitting this form, you are being duly sworn to hereby state the following:
I have created, and have maintained ownership of the Myspace account at this URL:
Please select your reason for submitting this Declaration of Ownership form:
Declaration Purpose: *
I hereby authorize Myspace.com to change the log in email address for the aforementioned account to:
The following information should be used to verify my identity:
Signup email address associated with profile:*
Date of birth:*
Zip code listed on account:*
Name listed on account:*
City and State account was created:*
Artist genre listed on account (Artists only):
If you do not know any of the requested information above and have requested that your profile be deleted,
please attach a digital image of your government issued ID. Please conceal all private information, but your
name. Once we use this image to confirm your identity, we will permanently delete it from our records, along
with the profile on Myspace.
Electronic Signature: *
Pursuant to this Attestation, I waive any claims against, indemnify and hold harmless Myspace, Inc., its
affiliates, and their respective directors, officers, agents, and employees from and against any claims,
damages or expenses relating to or arising from, in whole or in part, the disclosure of such information,
records and data. I have not been promised anything in exchange for providing this consent and authorization.
By signing this, I swear under penalty of perjury that the information contained in this document is true and
correct, and that the aforementioned Myspace account was created and maintained by me.
If you are under the age of 18, please print this page, have your parent or legal gardian sign it, scan and send the form to us as an attachment.
Myspace Member's Signature: ___________________________________
Guardian Signature: ___________________________________________