Request Type
/ o Loan: Will Pay fee:TN: / þ Loan / o Photocopy: Max. Cost :
o Other: ______
FROM: / LENDING LIBRARY REPORT:
Date Shipped:______Via:______
o Insured for $______Charges:
*** Due On: ______***
o Please Return Insured
Packing Requirements:______
Patron Name:
Membership No: / RESTRICTIONS:
o In Library Use Only
Newspaper Title: / o Duplicating Not Permitted
Town of Publication:
Date(s): / o No Renewals
o Other:______
Manuscripts; Census; / NOT SENT BECAUSE:
Plat Maps / Atlases; / o In Use o Lacking o Not Owned
County History; etc. / o Non-Circulating o Poor Condition
o Re-request on:______
Verified in: / o Estimated Cost of Item: $______
Type of Item: o Copy o Book o Fiche
TO: / Interlibrary Loan Department / [X] Prepayment Required
State Historical Society of Missouri / BORROWING LIBRARY REPORT:
1020 Lowry Street / Received:______Returned:______
Columbia, MO 65201-7298
Fax: 573-884-4950
Phone: 573-882-1187
Email: / Returned Via:
o Insured for $______
Contact: / o Payment Provided $______
Phone: / RENEWALS:
Email: / Date requested:
New due date:
Renewal denied:
The State Historical Society of Missouri retains reproduction rights to its microfilm. Microfilm may be used for research following copyright laws. Microfilm reels from the State Historical Society may not be duplicated in any format including, but not limited to digital copies.
The copyright law of the United States (Title 17, U.S. Code) governs the making of photocopies or other reproductions of copyrighted material. Under certain conditions specified in the law, libraries and archives are authorized to furnish a photocopy or other reproduction. One of these specified conditions is that the photocopy or reproduction is not to be “used for any purpose other than private study, scholarship, or research.” If a user makes a request for, or later uses, a photocopy or reproduction for purposes in excess of “fair use,” that user may be liable for copyright infringement.