"Request for Use of State Aircraft" - Mississippi

Request for Use of State Aircraft is a legal document that was released by the Mississippi Department of Finance and Administration - a government authority operating within Mississippi.

Form Details:

  • Released on June 1, 2020;
  • The latest edition currently provided by the Mississippi Department of Finance and Administration;
  • Ready to use and print;
  • Easy to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of the form by clicking the link below or browse more documents and templates provided by the Mississippi Department of Finance and Administration.

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REQUEST FOR USE OF STATE AIRCRAFT
SECTION I - AGENCY INFORMATION
REQUESTING AGENCY:________________________________________________________________________
CONTACT PERSON:_______________________________________ DATE:______________________________
PHONE #:______________________________________ FAX #:_________________________________________
SECTION II - FLIGHT INFORMATION
FLIGHT SCHEDULE
LEG
DATE
DEPART
CITY
STATE
ARRIVAL
CITY
STATE
# / PASS.
TIME
TIME
1.
2.
3.
4.
5.
6.
IS CATERING REQUESTED? IF SO, WHICH LEG? ________________________________________________
a. PURPOSE OF TRIP (BE SPECIFIC):____________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
b. NAMES OF PASSENGERS: (INDICATE IF NON-STATE EMPLOYEE [NSE])
SEC. III - PUBLIC OFFICIAL/AGENCY HEAD AUTHORIZATION AND RESPONSIBILITY
STATEMENT
I certify that the above request for utilization of State (DFA) operated aircraft is in accordance with State and Federal
Laws as well as the Policies and Procedures set forth by the Department of Finance and Administration.
___________________________________________
AIR TRANSPORT ONLY
Public Official or Agency Head
DATE REQUEST RECEIVED:
___________________________________________
REQUEST APPROVED BY:
Date
FLIGHT APPROVAL #:
Disclaimer: **This form can be sent by e-mail or fax but must be followed up with a telephone call to
confirm request.**
FAX COMPLETED/SIGNED FORM TO: Office of Air Transport Services @ 601-932-2989
OR E-MAIL TO: air.transport@dfa.ms.gov
Revised on June 2020
REQUEST FOR USE OF STATE AIRCRAFT
SECTION I - AGENCY INFORMATION
REQUESTING AGENCY:________________________________________________________________________
CONTACT PERSON:_______________________________________ DATE:______________________________
PHONE #:______________________________________ FAX #:_________________________________________
SECTION II - FLIGHT INFORMATION
FLIGHT SCHEDULE
LEG
DATE
DEPART
CITY
STATE
ARRIVAL
CITY
STATE
# / PASS.
TIME
TIME
1.
2.
3.
4.
5.
6.
IS CATERING REQUESTED? IF SO, WHICH LEG? ________________________________________________
a. PURPOSE OF TRIP (BE SPECIFIC):____________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
b. NAMES OF PASSENGERS: (INDICATE IF NON-STATE EMPLOYEE [NSE])
SEC. III - PUBLIC OFFICIAL/AGENCY HEAD AUTHORIZATION AND RESPONSIBILITY
STATEMENT
I certify that the above request for utilization of State (DFA) operated aircraft is in accordance with State and Federal
Laws as well as the Policies and Procedures set forth by the Department of Finance and Administration.
___________________________________________
AIR TRANSPORT ONLY
Public Official or Agency Head
DATE REQUEST RECEIVED:
___________________________________________
REQUEST APPROVED BY:
Date
FLIGHT APPROVAL #:
Disclaimer: **This form can be sent by e-mail or fax but must be followed up with a telephone call to
confirm request.**
FAX COMPLETED/SIGNED FORM TO: Office of Air Transport Services @ 601-932-2989
OR E-MAIL TO: air.transport@dfa.ms.gov
Revised on June 2020