To:Marsilio Editori3198, San Marco30124 Venezia, ItalyFAX: +39 41 5223051From: ... ...I authorise Marsilio Editori to request the documentreproduction request form from the Archivio di Stato di Venezia on my behalf.I understand I will be personally responsible for the use I intend to makeof the requested form. I also thereby agree that: