Historical Newspaper Article Reprint Permission Form
Applicant Name
Organization (if applicable)
Address
Email
Phone
Article Information
Article Title
Author (if known)
Publication Name
Publication Date
Page/Section (if known)
Intended Use
Describe how and where the article will be reprinted
Format of reprint (e.g., print, online, other)
Agreement
By submitting this form, I request permission to reprint the above historical newspaper article and agree to abide by any terms set forth by the rights holder.
Applicant Signature
Date