(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 of article, chapter, etc.:
From page_____, line_____, beginning with the words “_____________
__________________________________________,” to page ________
line_______, ending with the words “______________________________
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.
Copyright owner or agent Signature