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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 Rev. 6-17 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 Requestor Identification Name of requestor (Last, first, middle initial) Organization/Agency/Division Street address City State Zip E-mail address Telephone Number: (860) 757-2270 Fax Number: (860) 757-2215 Date of request Telephone number Fax number 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.) Will the requested material be published on a website or in other digital/electronic format? If so, is there a charge to use the website or other e-service? 9.) Estimated number of copies to be printed or produced. (If Intranet, number of users): 10.) Date(s) the material will be distributed: American LegalNet, Inc. www.FormsWorkFlow.com
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