Temporary Custody Receipt Of Hardware


Alabama Department of Archives and History
PO Box 300100, Montgomery, AL 36130-0100
Temporary Custody Receipt of Hardware
This form documents that the Alabama Department of Archives and History has received a hardware
device from another state agency for the purpose of transferring permanent electronic records.
Agencies should maintain copies of all the records they transfer to the Archives in the case
technological problems occur during the transfer. After the Archives verifies the records have
successfully transferred from the hardware device to the Archives’s server, the creating agency may
destroy the copies. The Archives will return the hardware as soon as the electronic records contained
on it have been transferred and verified. While at the Archives, the hardware will be kept in a secure
Date: ____________
State Agency Transferring Records: ________________________________________________
Agency Address: _______________________________________________________________
Authorized Agency Transferring Agent: _____________________________________________
Telephone: _______________________________
E-mail Address: _______________________________
Type of Hardware: ______________________________________________________________
Property Number/Identifying Number/Description of Hardware:__________________________
Signature of Authorized Agency Transferring Agent: ___________________________________
ADAH Staff Member Receiving Hardware: __________________________________________
ERHTCR Form 6/2011


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