Permission to Publish form

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PERMISSION TO PUBLISH MATERIALS FROM THE LILLY LIBRARY
Statement of Policy on Rights and Permissions
Permission to publish materials from the collections of the Lilly Library may be
requested by making written application to the Rights and Permissions Department, The
Lilly Library, Indiana University, using the form on the reverse side of this page.
There is no fee for the use of quotations or for citing materials from the collection. The
Application for Permission to Publish must still be completed.
It is the policy of the Lilly Library to charge a fee for the publication of each original
and/or rare item from its collections. Publication fees are separate from all
photoduplication costs and are payable prior to publication. Fees for the publication of a
large number of items may be negotiated.
We must caution you that the Lilly Library does not own reproduction rights to the
material in its collections, except in certain instances. Reproduction for publication
purposes, therefore, is subject to your securing permission from persons, corporations, or
other legal entities which may own or claim such rights under the copyright law. Under
the law effective January 1, 1978, both published and unpublished works are protected by
the copyright law. In addition to written works, the law also covers musical
compositions, drama, pantomimes, choreography, pictures, graphics, sculpture, sound
recordings, motion pictures, and other audiovisual creations. All responsibility for
questions of copyright that may arise in the use made of copies of our material must be
assumed by the applicant. All requests for permission to publish copyrighted material
must be accompanied by a letter of permission from the copyright owner.
The following credit line is required if material from the Lilly Library's collections is
published: Courtesy, The Lilly Library, Indiana University, Bloomington, Indiana.
RELEASE
In requesting permission to publish a copy of the item or items described on the reverse
side of this page, the undersigned agrees to indemnify and hold harmless the Lilly
Library from any action relating to infringement of the rights of any person or entity who
may claim legal rights in these item or items under common law or under statutory
copyright. These persons or entities may include, but are not limited to, authors, editors,
contributors, designers, illustrators, photographers, photographic subjects, artists,
printers, publishers, and binders, or their heirs, successors, and assigns.
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APPLICATION FOR PERMISSION TO PUBLISH
A letter accompanied by this form requesting permission to publish material should be
addressed to: Director, The Lilly Library, 1200 E. 7th Street, Indiana University, Bloomington,
Indiana 47405-5500. We cannot process your request unless the following information is
supplied in full.
I wish to reproduce from the following Lilly Library material(s):
Author:
Title:
Place of Publication:
Date of Publication:
Name of collections and/or call number:
Page Number or Description of Item to be Reproduced, Quoted, or Cited:
(1f more space is needed attach additional sheets.)
Purpose for which reproduction is desired, including:
Author and title of planned publication:
Publisher:
Type of publication (i.e., textbook; fiction, juvenile, scholarly work, etc.) and media:
Date of publication:
Edition: (i.e., first, second, reprint, etc.)
For use in advertisements:
In accordance with the foregoing rules and regulations of the Lilly Library, 1 hereby apply for
permission to publish the above-mentioned items.
Request made by (individual):
Representing (firm name):
Signature:
Street address:
City and State:
Phone:
Email Address:
Date:
Zip code:
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