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(Copyright owner’s name) (Copyright owner’s address) (City, State, Zip code) Dear (copyright owner’s name): I would appreciate receiving your permission to use, without charge, in a (intended use of material), the following material from your (book/periodical). This material will be placed in the California State University, Sacramento Library's Course Reserve Environment: Title: Copyright owner: Author: Title of article, chapter, etc.: From page_____, line_____, beginning with the words “_____________ __________________________________________,” to page ________ line_______, ending with the words “______________________________ ____________.” Illustrations:________________________________________, Appearing on page(s) _________________. Proper acknowledgement of title, author, copyright owner, and copyright date will be given. Would you kindly indicate your permission below and return this request? An extra copy is enclosed for your records. Sincerely, Requestor’s name Requestor’s title Permission granted: ________________________________ _____________________________ Copyright owner or agent Signature
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