Form Bas-6 - Boundary And Annexation Survey (Bas) - Consolidated Bas - U.s. Census Bureau

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BAS-6

U.S. DEPARTMENT OF COMMERCE

FORM

(10-12-2011)

Economics and Statistics Administration

BOUNDARY AND ANNEXATION SURVEY (BAS)

U.S. CENSUS BUREAU

CONSOLIDATED BAS

To sign up for the Consolidated BAS (C-BAS) program, please complete this form.

GENERAL

• It is important that all questions on the form are answered completely.

INSTRUCTIONS

• Return the completed form(s) by August 1st for your county to be consolidated for next year’s BAS.

• For further information, please contact the Legal Areas Team by calling (301) 763-1099 or emailing geo.bas@census.gov.

Name of county, parish, borough or equivalent area

State

BAS ID

STATE CODE

COUNTY CODE

Section 1

CONSOLIDATED BAS MAILING ADDRESS

(Address where Consolidated BAS materials should be sent) – Please fill in contact information below.

Name:

Address:

Position:

Department:

City:

ZIP code

Telephone:

(

)

–

Ext:

State:

Fax:

(

)

–

E-mail:

Instructions for filling out this form:

1) After contacting each of the entities listed below, enter a Y (Yes) or N (No) in the "Agreed" column to note each entity’s response to participating in the

Consolidated BAS program.

2) Fill in the name, position and phone number of the contact person you spoke with from each entity. Please provide this information for all entities listed below.

3) Enter the date that you spoke with each entity contact in the "Date of Contact" column.

Section 2

PARTICIPATION ROSTER

Agreed?

Date of

BAS ID

Entity Name

Contact Name

Position

Telephone Number

Y/N

Contact