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Copyright Permission Sample Letter 


Copyright Holder/Publisher

Street Address

City, State Zip

Attn: Copyrights and Permissions Department



Dear Sir or Madam:


Regarding the following title and information, I would like permission to retain a copy of the following material on reserve in the library at North Central Missouri College.


Author or Editor:  ________________________

Article or Chapter:  _________________________________

Periodical or Book title:  _____________________________

For Periodical: Volume #  ____   Issue Date: _____   Pages: ______  ISSN: ________

For Book: Copyright date: ___________   Pages:  _____   ISBN: ___________________

Number of copies to be placed on reserve: _______

Item will remain on reserve until: ___________________________


The copy will be used exclusively for educational purpose, with no direct or indirect commercial advantage, and will include a notice of copyright for students enrolled in my class.


Thank you for considering my request; I am looking forward to your reply.  If you have any questions, contact

Ann Sampson at the address listed below, or by phone 660-359-3948 extension 1322, or email





[Signature of instructor]




North Central Missouri College

1301 Main Street

Trenton, MO 64683