This is a sample only and should not be construed as a substitute for legal advice, nor is this resource comprehensive on the subject of copyright.
The request should be sent, together with a self-addressed return envelope, to the copyright owner (author) or permissions department of the publisher in question.
Dear Copyright Owner of Permissions Editor:
I am writing to ask your permission to (circle all that apply)
the following material:
If you do not solely control copyright in the requested materials, I would appreciate any information you can provide about others to whom I should write, including most recent addresses if available.
Please initial any statement that applies:
_________ I hereby represent that I have the authority to grant the permission requested herein.
_________ I am the sole owner/author of the work.
Name of authorized signatory