Leasing Action Request Form - Division of Facilities Services || Alaska Department of Transportation & Public Facilities

DOT&PF Lease Action Request Form

Contact Information

Name: *

Email: * SOA only Department: * Division(s): * Location (City/Town): *

Is this lease action affecting an existing lease? *

YES

If you selected YES, please specify the lease number. Otherwise, input "N/A" *

Which action from the list below would you like to take? *

New Lease or Extension

Type of Space(s) required: Are you going to be leaving existing leased space? *

YES

Existing Lease move-out date (est.): *

Projected move-in date (est.):

Old term: *

New term: *

Would you like this lease agreement to contain additional renewal options? *

YES

If YES, how many?

Projected budget for term of request (est.): *

Number of budgeted PCNs that will be in this lease: *

Mission critical requirements: Additional information:

If there is an additional document as part of this request, please attach it here:

I certify that the facts herein and on supporting documents are correct, that this request constitutes a legal charge against funds and appropriations cited, that sufficient funds are encumbered to pay this obligation, or that there is a sufficient unencumbered balance in the appropriation cited to cover this obligation. I am aware that certifying false, inaccurate or misleading documents constitutes an unsworn falsification under AS 11.56.210 *

YES