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Domain Authorization Letter: Independent intrastate

[Independent Intrastate Governmental Organization Letterhead]

[Date]

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

Dear Domain Manager,

As ([executive title] for [Independent Intrastate Governmental Organization name]), I formally request that authority over the [xxxxx.gov] second-level domain name be delegated to ([Independent Intrastate Governmental Organization name]).

[Describe how your organization is a bona fide government organization that is independent of your state. Include links to (or add as an appendix) authorizing legislation, applicable bylaws or charter, or other documentation to support your claims.]

This domain name will be used for [state the purpose]. The use of this domain is consistent with organizational Internet policy. In addition, I will ensure the content of the requested domain name conforms to the .gov policy.

By requesting this domain name, I acknowledge that I will be responsible for payment of the annual $400 domain fee. I understand that if I wish to retire my domain, I must submit a written request to registrar@dotgov.gov. If a written request is not submitted, I understand that I will continue to be responsible for all accrued domain fees.

The following individuals will be listed as points of contact for [xxxxx.gov]. It is understood that the contact information must remain valid and up to date, and that administrative, billing, and technical points of contact will be unique.

Administrative Point of Contact
First Name, Last Name
Title
Address
Phone Number
Email Address

Billing Point of Contact
First Name, Last Name
Title
Address
Phone Number
Email Address

Technical Point of Contact
First Name, Last Name
Title
Address
Phone Number
Email Address

Security Point of Contact [recommended, see https://home.dotgov.gov/management/security-best-practices/#add-a-security-contact] Email Address

Sincerely,
[Signature]

[Name]
[Title]