State Owned Housing

Lease Agreement Instructions

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 or mailto:Linda.Hubeny@CT.GOV.

Employee Name

Agency Name

DPW will complete

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:

Street Address City/Town

Date signed by Agency and Resident

Biweekly rate times (X) 26.1Found onCert. Form

% for living on State Institutional Grounds

If blank, type in“Leased Premises”and remove brackets

Select proper housingoption and delete inapplicable option

Town/City whereproperty is located

List occupants

Lessor responsiblefor all UtilitiesEXCEPT ones checked, if applicable

If applicable, both parties need

to initial each“check mark”

Both partiesinitial, if applicable

Resident is responsibleFor all Utilities EXCEPTthe ones checked, if applicable

Both partiesinitial, if applicable

If applicable, both parties need to initial each“check mark”

DPW will requirea copy of the policy after the lease is fullyexecuted

Resident’s signatureand date signed

Two Witnesses Signatures

City, County, and Date

Name of Resident

Notary Sealmust be used

Notary Signature

Agency NameSignature of authorized Agency Designee

Name and title of person signing

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

Place a “check mark” on all that applyBoth parties must initial

Fill in all information

Date of Inspection

Resident name andSignature

Agency Name andsignature of authorized designee

Use a “check mark”on all that apply

Initial all that apply

Authorized agency designee and resident signatures and date signed

Any ???

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