AR Form 450-03C (09/01/15)

COMPUTER INFORMATION HARD DRIVE REMOVAL CERTIFICATION

PURPOSE: To provide documentation that due diligence is being applied in removing information/hard drives from data devices. Information that must be removed includes: personal, sensitive, or confidential state data, proprietary software, or any other data required by state or federal law.

I certify that all devices listed by serial number on the attached Declaration of Surplus Property, Form 276, have had actions completed as noted to meet data removal standards in accordance with Colorado Data Destruction Policy and Computer, Electronic Media End-of-Life Policy standards published by the Governor’s Office of Innovation and Technology.

Date: ______

Action or method used: ______

Electronic waste recycler name, address and telephone number if applicable:

______

Responsible individual

______Printed name Signature

______Title/position

______Agency name Telephone number

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