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Reprints And Permission Request JD-ES-209 - Connecticut

Reprints And Permission Request Form. This is a Connecticut form and can be used in Administrative Statewide .
 Fillable pdf Last Modified 2/28/2007
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REPRINTS AND PERMISSION REQUEST JD-ES-209 New 4-06 NOTE: All republished material must carry Judicial Branch credit. Unless specifically noted otherwise, all permission is given for one-time use only. CONNECTICUT JUDICIAL BRANCH DIVISION OF EXTERNAL AFFAIRS 231 Capitol Avenue Hartford, CT 06106 www.jud.ct.gov Telephone Number: (860) 757-2270 Fax Number: (860) 757-2215 DATE OF REQUEST TELEPHONE NUMBER FAX NUMBER REQUESTOR IDENTIFICATION NAME OF REQUESTOR (Last, first, middle initial) ORGANIZATION/AGENCY/DIVISION STREET ADDRESS CITY STATE ZIP EMAIL ADDRESS REQUEST DESCRIPTION 1.) List the material that you are seeking to reprint: 2.) State the purpose and manner in which the material will be used: 3.) Describe the mission of the organization seeking permission: 4.) State whether the material requested will be used for commercial purposes and if so, in what manner: 5.) Will a profit be derived from the use of the copyrighted material? 6.) Will there be a charge for the product or program that includes the copyrighted material? 7.) If the requested material is to be placed in a publication, provide the name of the publication, and the context in which the material will appear: 8.) Estimated number of copies to be printed or produced. (If Intranet, number of users): 9.) Date(s) the material will be distributed: American LegalNet, Inc. www.FormsWorkflow.com
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