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Surplus Property Electronic Media Sanitization Declaration Form - Alabama Department Of Economic And Community Affairs

Surplus Property Electronic Media Sanitization Declaration

DECLARATION

Purpose: The following statement certifies to the Surplus Property Division of the

Alabama Department of Economic and Community Affairs (ADECA) that all electronic

storage media contained within the identified information system(s) has been sanitized

of all data in accordance with State Media Sanitization Standards and applicable

property management requirements.

With regard to the items listed on the following SD-1(s):

____________________________________________________________

[

]

Property Manager: Enter State Auditor Number(s) from Form SD-1

I, __________________________________________________________,

[

]

Printed name of person responsible for media sanitization (Technician; IT Manager)

_________________________ of________________________________,

[

]

[

]

Title

Organization

do hereby confirm that all electronic media in the above-listed items has

been sanitized of all data in accordance with State IT Standard 681S3:

Media Sanitization.

_____________________________________

_________________

Signature

Date

Endorsement of Agency Director (required by State Auditor’s Office):

_____________________________________

_________________

Signature

Date

Routing and Retention: Forward this completed form to the Division Property Manager.

Original form must accompany the SD-1(s) when the equipment is turned in to ADECA

Surplus Property Division. A copy of the complete form shall be retained by the Division

IT Manager. Retain completed forms for no less than three years.

Surplus Property Electronic Media Sanitization Declaration– V.1.0

February, 2012

Surplus Property Electronic Media Sanitization Declaration Form - Alabama Department Of Economic And Community Affairs