Agreement for Modification

STATE OF FLORIDA

DEPARTMENT OF MANAGEMENT SERVICES

AGREEMENT FOR MODIFICATION

TO CHANGE EFFECTIVE DATE

LEASE NO.:

MODIFICATION NO.:

WHEREAS, the Department of ______,Lessee, has previously entered into Lease Number______,on ______, 20___., for a term commencing______, 20______,; the Lessor being the ______.

WHEREAS, the current description of the leased premises is: (Current Description)

WHEREAS, both the Lessor and the Lessee wish to amend and modify said lease so as to

change the effective date of the lease;

NOW, THEREFORE, in consideration of the mutual promises and covenants herein

contained, the parties hereto hereby agree as follows:

1. The above described Lease Number______is hereby amended and modified to change the effective date to the ______day of ______, 20___.; as shown on the revised rent rate schedule addendum attached.

2. The covenants and conditions contained in the original State of Florida, Department of Management Services’ Lease Agreement Number as amended by the above modifications, are readopted by the Lessor and Lessee and incorporated herein.

LEASE NO.:

MODIFICATION NO.:

IN WITNESS WHEREOF, the parties hereto have hereunto executed this instrument for the purpose herein expressed, this day of , 20 .

ANY MODIFICATION OF A LEASE AGREEMENT SHALL NOT BECOME LEGALLY EFFECTIVE UNTIL APPROVED/ACCEPTED BY THE DEPARTMENT OF MANAGEMENT SERVICES.

ORIGINAL SIGNATURES REQUESTED ON ALL COPIES

Signed, sealed and delivered in the presence of:
______
Witness Signature
______
Print or Type Name of Witness
______
Witness Signature
______
Print or Type Name of Witness
AS TO LESSOR / Lessor, if INDIVIDUAL (s):
______(SEAL)
______
Print or Type Name
(SEAL)
______
Print or Type Name
Signed, sealed and delivered in the presence of:
______
Witness Signature
______
Print or Type Name of Witness
______
Witness Signature
______
Print or Type Name of Witness
As to President, General Partner, Trustee / Name of Corporation, Partnership, Trust, etc.:
By: (SEAL)
Its President, General Partnership, Trustee
ATTEST: (SEAL)
Its Secretary
Signed, sealed and delivered in the presence of:
______
Witness Signature
______
Print or Type Name of Witness
______
Witness Signature
______
Print or Type Name of Witness
AS TO LESSEE / LESSEE:
STATE OF FLORIDA
DEPARTMENT OF
By:______
______
Print or Type Name
______
Print or Type Title
Approved As To Conditions and Need Therefore
Department of Management Services
______Chief,
Division of Real Estate Development and
Management
______, Director
Division of Real Estate Development and
Management
Approval Date: ______/ Approved As to Form and Legality, Subject Only To Full and Proper Execution by the Parties
General Counsel
Department of management services
By: ______
______
Print or Type Name
Approval Date: ______/ Approved As to Form and Legality, Subject Only To Full and Proper Execution by the Parties
General Counsel
Department of
By: ______
______
Print or Type Name
Approval Date: ______

FM 4059 (R05/04)1 of 2