Fillable Instructions for Statement of Removal of Personal Identifying (Colorado Judicial Branch)

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Instructions for Statement of Removal of Personal Identifying (Colorado Judicial Branch)

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PII_REQ_REM_HELP
Page 1 of 3
Rev. 11/18/2019
Instructions for Statement of Removal of Personal Identifying Information
We highly recommend that you contact our office at 303-894-2200, option 2, if you have any questions about
completing the Statement of Removal of Personal Identifying Information form. It is very important that you carefully
review the instructions provided.
Information entered in the form/cover sheet may be lost if you select the Internet browser’s “Back” button.
WARNING: The Statement of Removal of Personal Identifying Information will be available as a publicly accessible
record after it has been accepted for filing by the Secretary of State’s Office. The Statement of Removal of Personal
Identifying Information will appear online as an event line on the History and Documents page in the record of the
affected entity, trade name, or trademark.
DO NOT repeat the personal identifying information to be removed when completing the Statement of Removal of
Personal Identifying Information.
DO NOT include personal identifying information in the Statement of Removal of Personal Identifying Information.
Use these instructions when completing a Statement of Removal of Personal Identifying Information pursuant to
§ 7-90-306 (5) and part 3 of article 90 of title 7 of the Colorado Revised Statutes (C.R.S.). The required form/cover
sheet must be used when submitting the document for filing. Information included in the document must be typewritten
or machine printed and must be in English. Mistakes may have legal consequences: review the information provided
carefully. The Colorado Secretary of State’s Office cannot provide legal advice. Questions should be addressed to your
legal, business or tax advisor(s). Only provide information that is required or permitted to be included in the document.
Do not include personal identifying information, such as a social security number. All information entered in the
form/cover sheet or included in an attachment will be made a matter of public record and immediately accessible on the
Secretary of State’s website. In order to obtain a copy of the filed document or access additional information, including
Frequently Asked Questions (FAQs), visit our website, www.sos.state.co.us.
Instructions
Section 1: The name of the individual making the request to remove personal identifying information should state his
or her full name.
Example 1: Jane Smith
Example 2: John Smith, III
Section 2: Enter the 11-digit number that identifies the entity whose record contains personal identifying information
in one of the publicly accessible documents associated with the entity. The Business Division of the Colorado Secretary
of State’s Office assigns the ID number. The ID number is not a state or federal tax number or a social security number.
A record number can be found by visiting our website, www.sos.state.co.us, and clicking on “Business Search”. Enter
the entity name, trade name or trademark description. The ID number will appear to the left of the name on the
Business Search Results page. Select the ID number to view the Summary page for the entity, trade name, or trademark
to confirm that you have selected the appropriate ID number.
Next, enter the entity name, trade name, or trademark description associated with the document in which the personal
identifying information appears. Enter the name or description exactly as it appears in the records of the Colorado
Secretary of State.
Example: A social security number appears in an attachment to the Articles of Amendment, document
number 20051000000 for XYZ, Incorporated. XYZ, Incorporated has an ID number of 20011999999.
PII_REQ_REM_HELP
Page 2 of 3
Rev. 11/18/2019
• 20011999999 should be entered in the first field of the section.
• XYZ, Incorporated should be entered in the second field of the section. (Note: Enter the name exactly
as it appears in the records of the Secretary of State. Do not enter “XYZ”, “XYZ, Inc.” or any other
variation of the name.)
Section 3: Enter the 11-digit number of the document containing personal identifying information.
A document number can be found by visiting our website, www.sos.state.co.us, and clicking on “Business Search”.
Enter the entity name, trade name or trademark description. The ID number will appear to the left of the name on the
Business Search Results page. Select the ID number to view the Summary page for the entity, trade name, or trademark
From the Summary page, select “View History and Documents”. Select the document number to view the document. A
PDF image of the document will open. Verify that this is the document containing personal identifying information,
and then enter the document number that you selected in the field.
Example: A social security number appears in an attachment to the Articles of Amendment, document
number 20051000000 for XYZ, Incorporated. XYZ, Incorporated has an ID number of 20011999999.
• 20051000000 should be entered in the field for this section.
Section 4: Describe the information to be removed. Please provide detail so that only the necessary information will be
removed.
Example 1: a nine-digit number that comprises a social security number.
Example 2: a four-digit personal identification number.
Example 3: an eight-character sequence that comprises a password.
Section 5: This section affirms that the information being removed is not required by law to be part of the filed
document.
Section 6: Describe in detail the location of the personal identifying information in the document. Please make
specific reference to where it appears in the document identified in Section 3 above.
Example 1: In a document where a social security number has been entered in the “last name” field for the
registered agent name, the following would be an acceptable description of the location: “On page three,
section 2, in the last name field of the registered agent name, the numbers following “Smith” to the end of the
last name field.”
Section 7: This statement affirms that the person requesting removal of personal identifying information recognizes
that the form/cover sheet will be available in the publicly accessible records of the Secretary of State.
Section 8: Enter an address where the Secretary of State may contact the person requesting removal. This address will
appear in the public records; therefore, do not use an address that you do not wish to be publicly accessible.
Section 9: Notice: This section describes the legal authority for filing this document. Refer to § 7-90-301.5, C.R.S. for
more information.
Individual Causing Delivery: Pursuant to § 7-90-301.5, C.R.S., each individual causing the document to be filed is
responsible for complying with the applicable statutes. Provide the last name, first name and address of at least one
PII_REQ_REM_HELP
Page 3 of 3
Rev. 11/18/2019
individual causing the document to be delivered for filing. A middle name or initial and a suffix are optional. The
mailing address, including the city, state and ZIP/postal code, must be provided. Any address outside of the United
States must include the country and, if applicable, the province.
Example: Smith, John
123 N. Main St., Apt 101
Denver, Colorado 80122
Additional Individuals Causing Delivery: If only one individual is causing this document to be filed, do not mark the
box. Mark the box if more than one individual is causing this document to be filed, and include an attachment with the
names and addresses of additional individuals causing the document to be filed. The attachment must provide the name
of each additional individual, including their last name and first name. A middle name or initial and a suffix are
optional. Also provide the mailing address, including the city, state and ZIP/postal code. Any address outside of the
United States must include the country and, if applicable, the province.
Disclaimer: These instructions, and the related form/cover sheet, are not intended to provide legal, business or tax
advice, and are offered as a public service without representation or warranty. While the related form/cover sheet is
believed to satisfy minimum legal requirements as of its revision date, compliance with applicable law, as the same
may be amended from time to time, remains the responsibility of the user of this form/cover sheet. Questions should be
addressed to the user’s attorney.
Document processing fee: FREE
Fees & forms/cover sheets
are subject to change.
Paper documents must be typewritten or machine printed.
ABOVE SPACE FOR OFFICE USE ONLY
0BStatement of Removal of Personal Identifying Information
filed pursuant to § 7-90-306 of the Colorado Revised Statutes (C.R.S.)
1. My name is ___________________________________________________________________. I am 18 or more
years of age. Pursuant to § 7-90-306, C.R.S., I am duly authorized to deliver a written request to the Colorado
Secretary of State to remove personal identifying information from the publicly accessible documents and other
records of the Secretary of State.
2. The ID number of the record containing
a publicly accessible filed document that
contains personal identifying information is _______________________________________________.
The entity name, trade name, or trademark description to which such record relates is
____________________________________________________________________________________________.
3. The document number of the filed document
that contains personal identifying information is ________________________________________.
4. The type of personal identifying information requested to be removed from such document is
_____________________________________________________________________________________________.
(Caution: Do not restate the personal identifying information requested to be removed.)
5. The personal identifying information to be removed is not required by law to be included in such document or other
records of the Secretary of State.
6. The location of the personal identifying information in the filed document described above is
_____________________________________________________________________________________________.
7. I understand that this document may be filed in the publicly accessible records and I consent to such filing by the
Secretary of State.
8. If the Secretary of State refuses to file
this document, notice of such refusal may
be delivered to the following mailing address: ______________________________________________________
(Street number and name or Post Office Box information)
______________________________________________________
___________________________ ______ _________________
(City) (State) (ZIP/Postal Code)
___________________________ ________________.
(Province – if applicable) (Country)
PII_REQ_REM Page 1 of 2 Rev. 9/9/2009
PII_REQ_REM Page 2 of 2 Rev. 9/9/2009
Notice:
Causing this document to be delivered to the Secretary of State for filing shall constitute the affirmation or
acknowledgment of each individual causing such delivery, under penalties of perjury, that such document is such
individual's act and deed, or that such individual in good faith believes such document is the act and deed of the person
on whose behalf such individual is causing such document to be delivered for filing, taken in conformity with the
requirements of part 3 of article 90 of title 7, C.R.S., and, if applicable, the constituent documents and the organic
statutes, and that such individual in good faith believes the facts stated in such document are true and such document
complies with the requirements of that Part, the constituent documents, and the organic statutes.
This perjury notice applies to each individual who causes this document to be delivered to the Secretary of State,
whether or not such individual is identified in this document as one who has caused it to be delivered.
9. The true name and mailing address of the individual causing this document to be delivered for filing are
_______________________ ________________ ________________ _____
(Last) (First) (Middle) (Suffix)
_____________________________________________________________
(Street number and name or Post Office Box information)
_____________________________________________________________
____________________________ _______ ______________________
(City) (State) (ZIP/Postal Code)
_________________________ _________________.
(Province – if applicable) (Country)
(If applicable, adopt the following statement by marking the box and include an attachment.)
This document contains the true name and mailing address of one or more additional individuals
causing the document to be delivered for filing.
Disclaimer:
This form/cover sheet, and any related instructions, are not intended to provide legal, business or tax advice, and are
furnished without representation or warranty. While this form/cover sheet is believed to satisfy minimum legal
requirements as of its revision date, compliance with applicable law, as the same may be amended from time to time,
remains the responsibility of the user of this form/cover sheet. Questions should be addressed to the user’s legal,
business or tax advisor(s).
Mail form to:
Colorado Secretary of State
1700 Broadway Ste 200
Denver, CO 80290
Do not include this page with your filing.
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Instructions for Statement of Removal of Personal Identifying (Colorado Judicial Branch)

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Completed 2 May 2021

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