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Authorization To Use Copyrighted Materials
AUTHORIZATION TO USE COPYRIGHTED MATERIALS
By affixing my signature below, I certify that I am the true and lawful holder of the copyright, and I do hereby grant permission to [Name of person authorized] to publish, reprint, or excerpt this and only this material: [Description of material], such authorization granted only under condition that I be somehow credited in such publication as the author of said specified material.
Signed Date
Signed Date