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Permission To Use Copyrighted Material
FOR GOOD CONSIDERATION, the undersigned, as copyright holder, hereby grants permission to [Name], to reprint, publish and use for world distribution the following material:
[Outline or attach marked as exhibit "A"]
This material shall be used only in the following manner or publication:
(Outline intended use)
A credit line to acknowledge use of the material is [ ] is not [ ] (check one) required. If required, the credit line shall read as follows:
This Section for Notary:
STATE OF -------)
) ss: [date]
COUNTY OF ------)
On [Date] before me, [Name of Notary], notary, personally appeared [Name of Person(s) Involved], personally known to me (or proved to me on the basis of satisfactory evidence) to be the person(s) whose name(s) is/are subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their authorized capacity(ies), and that by his/her/their signature(s) on the instrument the person(s), or the entity upon behalf of which the person(s) acted, executed the instrument.
Witness my hand and official seal.
[Name of Notary Public]
My commission expires: [date]