REQUEST FOR AUTHORITY TO PAY

MOVING EXPENSES
DEPARTMENT NAME

NAME OF EMPLOYEE

SOCIAL SECURITY NUMBER

TYPE OF APPOINTMENT:

Original Promotion Reassignment Demotion Reinstatement
FROM	TO
CLASS TITLE
PLACE TO WORK
ANTICIPATED MOVE DATE:
POUNDS: (not to exceed 15,000 pounds maximum gross weight)
ESTIMATED COST:
JUSTIFICATION: Payment of moving expenses for this employee is in the best interest of the State of Florida for the following reasons:

ACTION TAKEN:	Approved	Disapproved
Agency Authorized Signature:
(Print Name)
(Sign)
(Date)

DP-A-4 Revised 5/97

J0JEM

1999-11-16

mcgillj

FDLES J&B OIT