Direktorju Državnega arhiva v GORICI

PREDMET: Sporočilo o objavi reprodukcij dokumentov, shranjenih v Državnem arhivu v Gorici

Podpisani/a ............................................................................................................................................... , rojen(a) v ..................................................dne ...........................  z bivališčem v ................................................... v ulici .....................................................................................................

sporočam, da nameravam objaviti

reprodukcije spodaj navedenih dokumentov, shranjenih v tem državnem arhivu, ki bodo opremljene s sledečimi pripisi:

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v knjigi / reviji z naslovom ...........................................................................................................................
avtor: ..............................................................................................................................................................
založba:  ........................................................................................................................................................
število predvidenih izvodov ...............................................,                cena €. .....................................

	Zavezujem se, da bo temu Arhivu brezplačno dostavil 1 analogno ali digitalno kopijo dela in 1 kopijo reprodukcije (glej okrožnico 33/2017 Generalnega direktorata za arhive).
	Nadalje se zavezujem, da bom navedel izvor slike z natančno arhivsko oznako, ki jo bom predhodno predložil v pregled direkciji Arhiva.

Kraj in datum .....…………………………..		    Podpisani/a ……………………………………… 

Priloga a:

Sporočilo o objavi reprodukcij dokumentov, shranjenih v Državnem arhivu v Gorici

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Gorica,  ……………………………..		    Podpisani/a …………………………………........