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* 1. Verify that you are currently a legal resident of the State of California (CA):

* 2. Verify that you are currently under the age of eighteen (18) years old by entering your birthday:

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* 3. From which of the following websites that Simon operates, are you seeking to have your content removed from?

* 4. Describe the exact content that you wish to be removed. If possible, please provide a URL to where it currently is posted:

* 5. Tell us more about you:

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