1. Lease Agreement Instructions
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, Trinity St., Hartford, CT for further processing.
If you have any questions regarding this procedure, please contact Linda Hubeny at or

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. Place a “check mark” on all that apply Both parties must initial
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