New Helfta PO Box 464 . Geneseo, NY 14454 . Email: . Tel: 585-243-1226 . Fax: 585-245-8610


Permissions License††††††††††††††††††††††††††††††††††††††† Date: ______________________


License agreement made between Licensor: Minhhang K. Huynh, artist / iconographer / calligrapher


and Licensee:__________________________________________Company:________________________________


Address: ______________________________________________________________________________________


Phone/Fax: ______________________________________Email:________________________________________


for permission to use the image(s) of ________________________________________________________________






with the below specifications:

1.        The image is not to be altered or renamed. (To be complete by the licensee)


††††††††††† a. Date of intended publication: ______________________________________________________

b. Design artist/printer/publisher: _____________________________________________________

c. Title of the book/CD/Tape: ________________________________________________________

d. Number of copies requested permission: ____________

e. Production is for __ profit /__ non-profit.  If for profit, how much will an item be sold for?


Others: _________________________________________________________________________


2.The foregoing permission is hereby approved and granted subject to, (To be complete by the licensor)

if the production is for non-profit,

___†† a/ giving ____ copies of the item published (i.e. tapes, CDís, or books) to the Licensor.

___ ††b/ a nominal charge of $ _____


if the production is for profit,

___ ††a/ a nominal charge of $ _____

___†† b/ a royalty fee of $ _____ (5% of the sale profit.This includes images to be used as the cover image (i.e. tapes, CDís,

books, etc.)

___†† c/ a royalty of $ _____ (40% of the sale profit. This includes the reproduction of the image itself (i.e. cards and posters)

3.Printing the following form of credit with the reproduced image (s):

Name of art work: _____________________________________

©YEAR, Minhhang K. Huynh. .Used with permission.


4.This permission shall terminate if

a/ any of the above terms is violated.

b/ the intended production is not published by the Licensee within 1 year of approval.
The foregoing outlines all terms of this permission. Licenseeís signature below shall indicate Licenseeís
††††††††††† understanding
and approval of the terms set forth herein.

_____________________________Date: ___________††††††† _____________________________Date: ___________
Signature of Licensor

______________________________________________†††††† ††††††††††††Minhhang K. Huynh††††††††††††††††††††††††††††††††††††††††††††††††††

Print name

Please send the complete Permissions License with 3 copies of the program or check made payable to

New Helfta Atelier . PO Box 464 . Geneseo, NY 14454



Updated April 15, 2009
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