Application for the permission to publish of the Marciana National Library

To the Director of the Biblioteca Nazionale Marciana, Venezia

I, the undersigned (Name) ... ... (Surname) ... ...
(Date of birth) ... ... (Address) ... ... request permission to publishin the work (Author) ... ... (Title) ... ... (Publishing House) ... ... (Journal) ... ... the photographic reproduction of the following work(s):(Description, collocation, number of pages planned for publication, specifyingif B/W or colour) ... ...

I, the undersigned, declare that as for now:

• I agree to supply to the Library, free of charge, with at least onecopy or an extract of the published work;
• I agree to cite in the caption all the elements that permit the identificationof the work, following the instructions provided by the Library;
• the print run of the work will be of ... ... copies and the market pricewill be set in Italian Lire at the price of ... ..., or (if this is thecase) it is a scholarly journal.