From: xxxxxxx (your name)
Date mm-dd-yyyy (today's date)

i give NCI permission to use the items listed below as a freebie.

1. xxxxxx (item name)

I am authorized to distribute these items as Freebies because

1. I made the items
2. Other (please state the reason)

The permissions of the items should be changed as follows before distribution:

1. copy, transfer and modify (change as appropriate)

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