REQUEST FOR ONE-TIME USE OF PHOTOGRAPHIC IMAGE
State Historical Society of North Dakota
SFN 3736 (rev. 3-94)

Requested by: __________________________________ _____Publication/broadcast
Address: ______________________________________ _____Exhibit
_____________________________________________ _____Other commercial use
Telephone: _____________________________________ Total fee: $__________
Type of use (Format, title, author and date of publication):



Items used:





Credit line must read: State Historical Society of North Dakota

Copy(s) of publication requested [Number requested ]

Conditions for permission to publish

  1. Credit must be given to the State Historical Society of North Dakota and to the creator of the item, if known.
  2. Permission is for one-time use only. The SHSND retains all rights to the items and they are to be used only for the purpose listed in the permission form.
  3. The SHSND reserves the right to limit the number of photographic copies; to restrict the use or reproduction of rare or valuable items; to ensure that materials from its files are reproduced in good taste; to make special fee quotations on items involving unusual difficulty in copying; to charge a higher fee than specified for a small number of rare or unique items; and to deny a request because of copyright regulations, privacy rights, or donor-imposed restrictions.
  4. The requestor is responsible for securing any necessary permission from the creator of the work or heirs, if known. The creator's name will be provided, if known. Consistent with these conditions for permission to publish, the requestor agrees to indemnify and save and hold harmless the SHSND (State Historical Board) and its officers and employees from any and all claims of any nature arising under this agreement, including specifically any action involving infringement of the rights of any person, heir, or descendant under statutory copyright.
  5. If requested as marked above, the requestor will donate one or more copies of the publication to the SHSND.
  6. The requestor is responsible for transcribing all desired identifying information on a photograph. Detailed information will not be recorded on the photograph order or permission form.
  7. The SHSND reserves the right to refuse to grant permission and/or provide photographic reproduction services to publishers and individuals who have not complied with these conditions in the past.
  8. Visual materials do not circulate. All reproduction work is done by the SHSND or under its direct supervision. No attempt is made to provide archival quality prints.

Approved for legal sufficiency. David E. Clinton, Assistant Attorney General (3-10-94)

Requestor agrees to the conditions specified and agrees to pay a use fee in addition to charges for reproduction.

Requestor:____________________________

Date: __________________

Permission is granted for the one-time use of the above listed items owned by the State Historical Society of North Dakota.

Signed:_______________________________

Date: __________________

Notice: Warning Concerning Copyright Restrictions

The copyright law of the United States (Title 17, U.S. Code) governs the making of photocopies and other reproductions of copyright materials.

Under certain conditions specified in the law, libraries and archives are authorized to furnish a photocopy or other reproduction. One of these specified conditions is that the photocopy or reproduction is not to be "used for any purpose other than private study, scholarship, or research." If a user makes a request for, or later uses, a photocopy or reproduction for purposes in excess of "fair use" that user may be liable for copyright infringement.

This institution reserves the right to refuse to accept a copying order if, in its judgment, fulfillment of the order would involve violation of copyright law.