I/we request permission to: ___ quote from ___ cite from ___ publish
materials from the collections of the Alabama Department of Archives and History listed below.
CONDITIONS
MATERIALS USED: ________________________________________________________________________________________________________
________________________________________________________________________________________________________
AGREEMENT
I/we agree to the conditions specified above.Signature and Title ___________________________________________________________ Date ________________
Title of proposed publication: ______________________________________________________
Author/Producer: __________________________________ Expected date of publication/release:________________
Address: _______________________________________________________________________
________________________________________________ Telephone: _______________________
This use is: ___ Non Profit ___ Educational ___ Commercial (Check one)
The result will be ___ Periodical ___ Book ___ Textbook ___ Web site/CD ___Other (Check one)
APPROVED __________________________________________________ , Assistant Director for Public Services |