I/We hereby grant to ____________________________________________ (“Filmmaker” or "Writer") permission to use the following copyrighted material (listed below) in a film (or TV) project in perpetuity. We are granting Filmmaker permission for non-exclusive rights to use the written work(s), image(s), and/or art object(s) described below in this and future editions of the following project:
_____________________________________________________ (Project Name)
Description of Copyrighted Material
Title: ____________________________________________________________
Description: ______________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
I/We ___________________________________________( “Publisher”) certifies that no other individual or parties holds copyright interest in the work(s) described above, that Publisher holds all rights to the works listed, and that the license granted herein does not violate any third-party rights or applicable laws.
Publisher hereby certifies and covenants that they are authorized to sign on behalf of the entity listed below.
Printed Name _____________________________________________________
Signature ________________________________________________________
Date _______________________________________
Publisher _______________________________________________________
Street Address ___________________________________________________
City, State ______________________________________________________
ZIP Code _______________
Phone Number _______________________________
Email Address _______________________________________
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