A. This form delineates conditions for publication and reproduction of images held by the SRCA as public records and shall be completed and submitted to the SRCA as provided in 1.13.2 NMAC and as evidence of agreement by the requestor to the terms and conditions prescribed therein and in 1.13.2 NMAC. Information contained on the form shall include, but not be limited to, the following:

1. (1) provision for reservation of rights by the SRCA;
2. (2) formats for required credit line;
3. (3) requirements relating to the method of payment; and
4. (4) description of respective rights and responsibilities of the SRCA and the requestor, including copyright restrictions, relating to reproduction and publication.

B. The form shall require of the requestor:

1. (1) the description of the image to be published and the required credit line;
2. (2) the printed name and signature of the requestor;
3. (3) the address of the requestor; and
4. (4) the date of the request.

C. The director of the archives and historical services division of the SRCA and the state records administrator shall approve the requested use by their signatures on the form.

[07/01/96, 1.13.11.14 NMAC - Rn, 1 NMAC 3.2.10.2, SRCA Form 96-18 & A, 07/15/03]