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Instructions: Please read the reproduction policies if you have not already done so. Then read this form thoroughly (two printed pages). Print and complete one copy. Mail/fax this copy with appropriate signatures to the Special Collections department. Please include your return address. A countersigned copy will be returned to you for your records. Click here for a printable version.
Permission to Publish/Use Form
Name__________________________________________________________
Address________________________________________________________
Telephone_________________________ Email________________________
Subject to the conditions listed below, I request permission to publish or otherwise use the following material from the collection of the State Library of Massachusetts. (If necessary, attach an additional sheet.) ______________________________________________________________________
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This material will be included in: (If a publication, include title, publisher, and date of publication.)
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Conditions for Use of Material
1. Proper credit ("Courtesy of the State Library of Massachusetts") must always be given. The person requesting permission to publish is responsible for the credit line.
2. Permission is granted, in advance, for one time use only. Reuse or resale is not allowed without specific authorization by the State Library of Massachusetts.
3. Permission to publish or otherwise use material is contingent upon completion of this form.
4. All material is retained in the State Library of Massachusetts and is never circulated or loaned for publishing purposes.
5. Photographic or digital negatives of State Library material made at a patron's request are the property of the State Library (see the Special Collections department reproduction policies).
6. The State Library of Massachusetts does not claim to control the rights of reproduction and distribution for material in its collection. The publishing party assumes responsibility for all infringements of copyright and invasion of privacy.
7. In authorizing publication of any material, the State Library of Massachusetts does not surrender its own right to publish or grant others permission to do so.
8. One complimentary copy of the publication will be given to the State Library of Massachusetts.
9. The State Library of Massachusetts reserves the right to changes these policies without prior notice.
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State Library of Massachusetts Date
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