Modified from sample in booklet "Fair Use of Copyrighted Works" by C.E.T.U.S.:

[letterhead stationery or return address]

[Date]

[Name & address of addressee]

Dear___________________________:

[If you called first, begin your letter:  This letter will confirm our recent telephone conversation.]  I am [describe your position] at ___________ University or Library or Company.  I would like your permission to  [explain your intended use in detail, e.g., reprint the following article in an anthology of RNCII papers]

             [insert full citation to the original work.]

Please indicate your approval of this permission by signing the letter where indicated below and returning it to me as soon as possible.  My fax number is set forth above.  Your signing of this letter will confirm that you own [or your company owns] the copyright to the above described material.

Thank you very much.
 

Sincerely,
[Your name and signature]

Permission granted for use requested above:

________________________________________
[Type name of addresses below signature line]
 

Date:___________________________