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Ajax Archives
Request to Publish, Exhibit or Broadcast Materials

Please complete this form to request permission for publication, exhibition or broadcasting of Ajax Archives materials.

Applicant Information

Details of Request

I am creating the following project
I would like permission to use the following, as listed below. (Please check all that apply).

You are required to provide the reference (Local Identifier # or Collection as identified in OurOntario), Title/Description of File or Item, and Date of Record(s) for which you are requesting permission. To find the Reference or Local Identifier number in for an item, please click on the title of the item to access the metadata information.

Collection of Personal Information

Personal information collected on this form is collected pursuant to the Municipal Act, 2001, s. 11(1), and will only be used for the purpose for which it is collected, and will not be distributed or used by the Town of Ajax for any other purpose. Questions about this collection may be directed to the Town of Ajax Records and Freedom of Information Coordinator at 65 Harwood Avenue South, Ajax, Ontario, L1S 2H9 or 905-683-4550.

Learn more about the Town of Ajax's Privacy Policy.


If you require this form in an alternative format, please contact the Town of Ajax Accessibility Coordinator, at 905-683-4550, or by e-mail at

Form: LIS-124

Revised: 20/01/22