State Owned Housing

1. State Owned Housing Lease Agreement Instructions

2. Instructions for Completing the Employee Housing Lease • Please fill in all blanks as indicated. •  For Section 3.2, the last blank may be filled in as “Leased Premises.” •  For Section 4.1 please be sure to select the proper housing option (single family residence or dormitory residence) and delete the inapplicable option. •  Sign the Lease as indicated on the signature page in blue ink. • Your signature must be notarized. Accordingly, you must sign the Lease in the presence of a Notary Public or a Commissioner of the Superior Court. Have the Notary Public or Commissioner of the Superior Court complete the acknowledgement block below your signature. Type or print the Notary Public’s or Commissioner of the Superior Court’s name below the signature; and, if the acknowledger is a Notary Public, please have the seal affixed over his/her signature. • You must sign the Lease in front of two (2) witnesses. One of the witnesses may by the Notary Public or the Commissioner of the Superior Court. Have the witnesses print or type their names under their signatures. •  Please complete attach all applicable exhibits to the Lease. If an exhibit is not applicable to the Lease, type “Not Applicable” on the exhibit. • Please proofread the Lease before it is signed. Make sure that all of the blanks are completed and brackets around blanks are removed. Do not show tracked changes in the final, execution copy. • Please forward the signed Lease to Linda Hubeny, DAS/State Employee Housing Program Manager, 18-20 Trinity St., Hartford, CT 06106 for further processing. • If you have any questions regarding this procedure, please contact Linda Hubeny at 860.256.2903 ormailto:Linda.Hubeny@CT.GOV.

3. LEASE THIS LEASE (the “Lease”) is entered into by and between the STATE OF CONNECTICUT, hereinafter called the “LESSOR,” acting herein by ______________ , its Commissioner of the Department of Public Works, duly authorized, pursuant to Section 4b-1 of the Connecticut General Statutes, as revised, and _____________________________, hereinafter called the “RESIDENT.” WITNESSETH: WHEREAS, the RESIDENT is an employee of the State of Connecticut Department of ______________ (the “Agency”); and WHEREAS, it is desirable to both the RESIDENT and the LESSOR that the RESIDENT reside in the Leased Premises (as hereinafter defined). NOW, THEREFORE, for valuable consideration and other mutual promises contained herein, the parties hereto agree as follows: DPW will complete Employee Name Agency Name

4. Street Address City/Town Date signed by Agency and Resident

5. Biweekly rate times (X) 26.1 Found on Cert. Form % for living on State Institutional Grounds If blank, type in “Leased Premises” and remove brackets

6. Select proper housing option and delete inapplicable option Town/City where property is located

7. List occupants

8. Lessor responsible for all Utilities EXCEPT ones checked, if applicable If applicable, both parties need to initial each“check mark” Both parties initial, if applicable

9. Resident is responsible For all Utilities EXCEPT the ones checked, if applicable If applicable, both parties need to initial each“check mark” Both parties initial, if applicable

10. DPW will require a copy of the policy after the lease is fully executed

11. Two Witnesses Signatures Resident’s signature and date signed City, County, and Date Name of Resident Notary Seal must be used Notary Signature

12. Agency Name Signature of authorized Agency Designee Name and title of person signing

13. If Exhibit is not Applicable to Lease type “Not Applicable” on the Exhibit.

14. Fill in all information Place a “check mark” on all that apply Both parties must initial

15. Date of Inspection Agency Name and signature of authorized designee Resident name and Signature

16. Use a “check mark” on all that apply

17. Initial all that apply Authorized agency designee and resident signatures and date signed

18. Any ??? • Contact Linda Hubeny • Phone: 860.713-5147 • Email:Linda.Hubeny@CT.GOV