Permissions Department
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Dear Sir or Madam:
I am writing to ask your permission to copy the following for classroom use next quarter, September 20XX:
Author:
Book Title:
Copyright:
Pages:
Distribution:
John Smith
The Life of John Smith, 3rd ed., 1982 (out of print)
1979, 1982
23-35 of Chapter 10 “Life Abroad”; (photocopy enclosed).
Number of Copies: 60 (3 sections of History 256 U. S. History to 1865)
Supplied to students as free handout fall quarter 2001
Type of reprint: Photocopy
Enclosed please find a self-addressed, stamped envelope for your convenience in returning this signed permission. If you do not solely control copyright of the requested material, I would appreciate any information you can provide about the copyright owners, including most recent addresses if available.
Sincerely,
Bob Jones
Professor
Clark College
Vancouver, WA 98663
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______ I hereby represent that I have the authority to grant the permission requested.
______ I am the sole owner/author of the work.
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