D-1667 Contact Information Update Form

FORM D-1667
(12-18-2006)

U.S. DEPARTMENT OF COMMERCE

CONTACT INFORMATION UPDATE FORM

Economics and Statistics Administration

U.S. CENSUS BUREAU

LOCAL UPDATE OF CENSUS ADDRESSES PROGRAM

Page
of

Our records indicate the following individuals are Contact Persons for your government. Please review the pre-printed
information for each contact person and, if incorrect, print in the updated information.
Entity name

Contact ID

Person
completing this
form – Please print.

Entity ID

Name

Phone

CONTACT PERSON(S)

Phone

Ext.

FAX
E-mail

Is the above information correct?

Yes

Title – Mark (X) one.

Ms.
Miss
Mrs.

Mr.
Dr.
Governor

The Honorable
Tribal President
Tribal Chief

No – Please make corrections below.
Position (e.g., Mayor, Assessor, Tribal Chairperson; please do not
abbreviate.)

Tribal Chairperson
Tribal Governor

Mailing address

Name
City
Name suffix – Mark (X) if appropriate.

Jr.

Sr.

II

III

State

ZIP Code

IV

Department name (e.g., Planning and Zoning, please do not abbreviate.)

Phone

Ext.

FAX
Please continue in next column.

E-mail

Phone

Ext.

FAX
E-mail

Is the above information correct?

Yes

Title – Mark (X) one.

Ms.
Miss
Mrs.

Mr.
Dr.
Governor

The Honorable
Tribal President
Tribal Chief

No – Please make corrections below.
Position (e.g., Mayor, Assessor, Tribal Chairperson; please do not
abbreviate.)

Tribal Chairperson
Tribal Governor

Mailing address

Name
City
Name suffix – Mark (X) if appropriate.

Jr.

Sr.

II

III

Department name (e.g., Planning and Zoning, please do not abbreviate.)

State

IV
Phone

Ext.

FAX
Please continue in next column.

NOTE – Within two
weeks of receipt,
please mail this
form using the
preaddressed
envelope, or fax the
form to:

ATTN: Geography
U.S. Census Bureau

USCENSUSBUREAU

E-mail
Phone
FAX
TDD

ZIP Code

pages