Declaration by library client
and authorized officer of the library
Date: Monday, 2 February 2015
To the officer in charge of the Soil And Health Library:
I request a reproduction of the book The Evolution of Civilizations by
I declare that I require the reproduction for the purpose of research and
study and I will not use it for any other purpose, and I have not previously
been supplied with a reproduction of the same material by an authorized
officer of the library.
(Your legal name).
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