State Form 54681 Publish or Exhibit Materials From the Indiana State Archives - Indiana

Form State54681 is a Indiana Archives and Records Administration form also known as the "Publish Or Exhibit Materials From The Indiana State Archives". The latest edition of the form was released in June 1, 2015 and is available for digital filing.

Download an up-to-date Form State54681 in PDF-format down below or look it up on the Indiana Archives and Records Administration Forms website.

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INDIANA ARCHIVES AND RECORDS ADMINISTRATION
PUBLISH OR EXHIBIT MATERIALS FROM
INDIANA STATE ARCHIVES
THE INDIANA STATE ARCHIVES
6440 East 30th Street
Indianapolis, IN 46219
State Form 54681 (R / 6-15)
Telephone number: 317-591-5222
E-mail: arc@iara.in.gov
Name of applicant (Author, Presenter, Curator)
Address (number and street, city, state, and ZIP code)
Telephone number
Fax number
E-mail address
(
)
(
)
Name of publisher / venue
Date requested (month, day, year)
Address (number and street, city, state, and ZIP code)
Title of Publication / Presentation / Exhibition, etc.
Projected date of completion (month, day, year)
Item(s) from collection of the Indiana State Archives to be used in the above publication / presentation / exhibition (must be cited specifically by collection
name, collection number, and date of document, or permission may not be granted): (Use second sheet, if necessary.)
Permission to utilize the sources indicated above is hereby granted, provided:
1. That written permission for the intended use is secured from the holder of copyright in the material when copyright is not held by Indiana State
Archives.
2. That the author / presenter and/or publisher / sponsor assume(s) full and complete legal responsibility for any infringement of copyright that might
occur from the use or publication of this material. The undersigned hereby indemnifies the Indiana Archives and Records Administration, and its
employees for any and all losses, costs, and legal fees that accrue to the Indiana Archives and Records Administration, from failure of the
undersigned to obtain appropriate permissions.
3. When using any item from the Archives collections, whether for exhibition, print publishing, or online publishing, proper credit must be given. This
should be placed near the image, if feasible, and in a footnote, endnote, or caption. The citation must include the collection name, the box number,
and the name of the repository - the Indiana State Archives.
Example for a manuscript collection:
January 25, 1954, John Doe to Mary Brown, John Doe Collection, L52, Indiana State Archives.
Example for a photograph:
April 1955, portrait of Jane Doe and husband. Indiana Picture Collection, Indiana State Archives.
4. The Indiana State Archives reserves the right to limit the number of images copied; to restrict the use or reproduction of rare or valuable material;
and to levy special use fees in certain circumstances.
5. In granting permission for publication or other use, the Indiana State Archives does not surrender its right to exhibit, publish, or otherwise reproduce
the materials, nor to grant permission to others to do so.
6. That a copy of any publication or product resulting from the use of this material, including any publicity or related documentation, be given to the
Indiana State Archives for its documentary files.
7. The permission to use the above listed material is for a one time use only. Additional use of the above listed material requires the granting of new
permission.
Failure to abide by the conditions of this contract may result in prosecution.
Signature of author / presenter / publisher / sponsor
Date of signature (month, day, year)
Signature of Indiana State Archives representative
Date of signature (month, day, year)
Title of the Indiana State Archives representative
Reset Form
INDIANA ARCHIVES AND RECORDS ADMINISTRATION
PUBLISH OR EXHIBIT MATERIALS FROM
INDIANA STATE ARCHIVES
THE INDIANA STATE ARCHIVES
6440 East 30th Street
Indianapolis, IN 46219
State Form 54681 (R / 6-15)
Telephone number: 317-591-5222
E-mail: arc@iara.in.gov
Name of applicant (Author, Presenter, Curator)
Address (number and street, city, state, and ZIP code)
Telephone number
Fax number
E-mail address
(
)
(
)
Name of publisher / venue
Date requested (month, day, year)
Address (number and street, city, state, and ZIP code)
Title of Publication / Presentation / Exhibition, etc.
Projected date of completion (month, day, year)
Item(s) from collection of the Indiana State Archives to be used in the above publication / presentation / exhibition (must be cited specifically by collection
name, collection number, and date of document, or permission may not be granted): (Use second sheet, if necessary.)
Permission to utilize the sources indicated above is hereby granted, provided:
1. That written permission for the intended use is secured from the holder of copyright in the material when copyright is not held by Indiana State
Archives.
2. That the author / presenter and/or publisher / sponsor assume(s) full and complete legal responsibility for any infringement of copyright that might
occur from the use or publication of this material. The undersigned hereby indemnifies the Indiana Archives and Records Administration, and its
employees for any and all losses, costs, and legal fees that accrue to the Indiana Archives and Records Administration, from failure of the
undersigned to obtain appropriate permissions.
3. When using any item from the Archives collections, whether for exhibition, print publishing, or online publishing, proper credit must be given. This
should be placed near the image, if feasible, and in a footnote, endnote, or caption. The citation must include the collection name, the box number,
and the name of the repository - the Indiana State Archives.
Example for a manuscript collection:
January 25, 1954, John Doe to Mary Brown, John Doe Collection, L52, Indiana State Archives.
Example for a photograph:
April 1955, portrait of Jane Doe and husband. Indiana Picture Collection, Indiana State Archives.
4. The Indiana State Archives reserves the right to limit the number of images copied; to restrict the use or reproduction of rare or valuable material;
and to levy special use fees in certain circumstances.
5. In granting permission for publication or other use, the Indiana State Archives does not surrender its right to exhibit, publish, or otherwise reproduce
the materials, nor to grant permission to others to do so.
6. That a copy of any publication or product resulting from the use of this material, including any publicity or related documentation, be given to the
Indiana State Archives for its documentary files.
7. The permission to use the above listed material is for a one time use only. Additional use of the above listed material requires the granting of new
permission.
Failure to abide by the conditions of this contract may result in prosecution.
Signature of author / presenter / publisher / sponsor
Date of signature (month, day, year)
Signature of Indiana State Archives representative
Date of signature (month, day, year)
Title of the Indiana State Archives representative
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