OFFICE OF THE STATE BUDGET
OFFICE OF FINANCIAL MANAGEMENT / STATE OF MICHIGAN EQUIPMENT LEASE QUESTIONNAIRE
(To be submitted with a copy of the purchase order and/or lease contract)

For definitions of the lease terminology used in this questionnaire, please refer to the glossary in the Financial Management Guide, Chapter 21, Section 1000 (Glossary), or, Section 700, Exhibit A.

Department / Agency / Lease Name / Lease Number (Purchase Order or Contract Number)
1. / a.Is this a new contract? / Yes No
b.A renewal of an existing contract? / Yes No
c.An addition or change to an existing contract? / Yes No
d.If the answer to 1. a. is "no", what original lease number is being renewed/changed? (Attach a copy of the original Purchase Order or Contract.)
2. / Is the state the lessee on a two party lease? / Yes No
3. / Does ownership transfer to the state at the end of the lease? / Yes No
4. / a.Is there a bargain purchase option? / Yes No
b.If the answer to 4. a. is "yes", what is the bargain purchase option amount? / $
5. / How often are payments made? (circle one)
Monthly / Quarterly / Semi Annually / Annually
6. / How many payments are required during the lease term?
7. / Indicate the leased equipment's estimated economic life (in months), if different than 60 months. For an explanation of estimated economiclife, please refer to FMG Chapter 21 Glossary or Section 700, Exhibit A. / Months
8. / a.At what price could the equipment be purchased (i.e., what is the estimated fair market value)? / $
b.What is the source of the information provided in 8.a. (buyer,
vendor)?
9. / a.Is the equipment's residual value guaranteed by the lessee? For an explanation of residual value, please refer to the FMG Chapter 21 Glossary or Section 700, Exhibit A. / Yes No
b.If the answer to 9. a. is "yes", what is the amount of the guarantee? / $
10. / a.Is there a penalty for failure to renew or extend the lease at expiration of the lease? / Yes No
b.If the answer to 10. a. is "yes", what is the amount of the penalty? / $
11. / a.Is the equipment's residual value guaranteed by someone other than the state or lessor? / Yes No
b.If the answer to 11. a. is "yes", what is the amount of the guarantee? / $
12. / What is the amount of any unguaranteed residual value accruing to the lessor at the end of the lease? / $
13. / a.Do the lease payment amounts remain the same throughout the lease term? / Yes No
13. / b.If the answer to 13. a. is "yes", what is the amount of the lease payment, excluding executory costs (i.e. maintenance, insurance, taxes)?* / $
c.If the answer to 13. a. is "yes", what is date of the first lease payment (MM/DD/YYYY)? / / / /
d.If the answer to 13. a. is "no", how many times does the lease payment amount change?
e.If the answer to 13. a. is "no", list each payment amount (exclusive of executory costs)*, the number of payments at that amount, and the date (MM/DD/YYYY) each payment amount begins.
Payment Amount / Executory Costs / Number of Pmts / First Payment Date
$ / $ / / / /
$ / $ / / / /
$ / $ / / / /
$ / $ / / / /
*If the lease is for computer equipment, do not include software costs.
14. / What is the annualized interest rate in the contract? / %
15. / What is the lease start date (MM/DD/YYYY)? The start date may or may not be the same as the first payment date. / / / /
Forward the completed questionnaire, and a copy of the purchase order and/or lease contract to:
OFFICE OF THE STATE BUDGET
OFFICE OF FINANCIAL MANAGEMENT
ACCOUNTING AND FINANCIAL REPORTING DIVISION
ROMNEYBUILDING, 7TH FLOOR
111 S. CAPITOL AVENUE

LANSING, MI48933

FOR OFFICE OF ACCOUNTING USE ONLY
A846
(Rev. 4/2005)