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Authorization letter template: Independent intrastate

[Independent intrastate governmental organization letterhead]

[Date]

.Gov Domain Registration
c/o Verisign, Inc.
12061 Bluemont Way
Reston, Virginia 20190

To the .gov Program:

As authorizing authority for [Agency Name], I request that responsibility for the domain name [___________.gov] be delegated to [Organization].

[Briefly describe your organization’s mission or initiative that drives the domain name request, explaining what the domain name will be used for. Describe how your organization is a bona fide government organization that is independent of your state’s government. Include links to, or add as an appendix, authorizing legislation, applicable bylaws or charter, or other documentation to support your claims.]

In order to obtain and maintain [___________.gov] [Organization] will meet the general and specific requirements for federal agencies, found at https://home.dotgov.gov/registration/requirements.

The following will be listed as contacts for [___________.gov], which [Organization] will keep up to date in the .gov registrar.

[Administrative, billing, and technical contacts are named individuals and must be unique; a security contact should generally be a team email address.

As of April 26, 2021, .gov domains no longer have a fee associated with them. However, the .gov registrar has not yet been updated to remove the billing contact role. Until then, you may consider the billing contact to be a secondary administrative contact.]

Administrative contact
First Last
Title
Address
Phone number
Email address

Billing contact
First Last
Title
Address
Phone number
Email address

Technical contact
First Last
Title
Address
Phone number
Email address

Security contact [recommended]
Email address

I understand that if I wish to retire [___________.gov], I must submit a written request to registrar@dotgov.gov.

Sincerely,
[Signature]

[Name]
[Title]