Copyright Permission Form 
for Funeral Booklets 
 
The University of the Virgin Islands (UVI) Libraries, in partnership with the Division of 
Libraries Archives & Museums (DLAM), has been awarded a National Leadership grant 
for digitization from the federal Institute of Museum and Library Services (IMLS). The 
award is given for the purpose of digitizing selected Virgin Islands material for improved 
access and preservation. UVI and DLAM are non-profit agencies committed to collecting 
and preserving resources to facilitate research and education in the Virgin Islands. 
 
We have identified a funeral booklet, developed for your deceased family member and 
held by the Enid M. Baa Library, as important to genealogical research and Virgin 
Islands studies. We are requesting your permission to digitize and create an electronic 
copy of the funeral booklet for the family member listed below.  This booklet will be 
made available for use both within the library and through the Internet. In addition, a 
copy of this document on CD-ROM will be made available, at no charge, to school 
libraries in the Territory. 
 
A statement will be included with the electronic file to identify your rights as copyright 
holder. 
 
Please indicate your permission by completing this form and signing below.  
 
Deceased Name  
 
Your Name  
 
Mailing Address  
 
City  ____________________________ State  ________  Zip Code  ________________ 
 
Phone ____________________________________ 
 
Relation to Deceased __________________________________ 
 
Other Family Members Consulted ___________________________________________  
 
_______________________________________________________________________ 
 
Permission Granted [  ] 
 
 
 
         Permission Denied [  ] 
 
Signature______________________________________  Date____________________