BAS-4 Boundary & Annexation Survey, Newly Incorporated Places

Form Approved: OMB No. 0607-0151; Approval Expires 07-31-10

BAS-4

U.S. DEPARTMENT OF COMMERCE
Economics and Statistics Administration
U.S. CENSUS BUREAU

FORM
(4-30-2008)

BOUNDARY AND ANNEXATION SURVEY (BAS)
NEWLY INCORPORATED PLACES AND NEWLY ACTIVATED GOVERNMENTS

GENERAL
INSTRUCTIONS

Question 1

PLACE
CODES

STATE
CODE

BAS ID

Former FIPS

To report a newly incorporated place or newly activated government, please complete this form.
• It is important that all questions on the form are answered completely.
• Please send in a map showing the boundaries of the new incorporation or newly activated government.
• Include a copy of the official papers of incorporation along with this form and the map(s).

INCORPORATION OF PLACE – Please complete all parts (a through h) of this question.

1a. What is the official name of this incorporated place?
Name
1b. What type of place is this? Mark (X) one box.

City

Town

Village

Borough

Other – Print type of place.
1c. What state is this incorporated place/newly activated government located in?
1d. List the counties or statistically equivalent
areas that this new incorporation extends into:
Attach an additional sheet if necessary.

Name:

Census code: (if known)

1.
2.
3.
4.

Month

Day

Year

1e. What is the official (effective) data of incorporation?
1f. Has this place been active since incorporation? (An active place is one that is legally incorporated and operates as a governmental unit;
i.e., it has officials and has the legal capacity to raise revenues and conduct governmental activities.)
Yes
Month

Day

Year

No – Please enter the official date of activation?
1g. At the time of incorporation or activation, what
was the estimated population and number of
housing units? – Enter estimates.

Estimated
population

1h. At the time of incorporation or activation, what
was the estimated area of this place or newly
activated government? – Enter estimate.

Estimated area
(in acres)

Question 2

Estimated number
of housing units

BOUNDARIES AT TIME OF INCORPORATION OR ACTIVATION

PLEASE SEND A MAP SHOWING, IN RED, THE BOUNDARIES OF YOUR NEWLY INCORPORATED PLACE OR NEWLY ACTIVATED
GOVERNMENT. YOU MUST INCLUDE A COPY OF THE OFFICIAL PAPERS OF INCORPORATION OR ACTIVATION.

USCENSUSBUREAU

Form Approved: OMB No. 0607-0151; Approval Expires 07-31-10

Question 3

CONTACT INFORMATION – Please fill in your contact information in the space provided below.
BAS Respondent

Mailing
Address

Mark (X) one government type for the BAS Respondent.

(The BAS Respondent is the person filling out this form.)

Local

County

Regional

Name
Address
Position
Department

City

Telephone

(

)

Fax

(

)

Ext.

E-mail

Mark (X) this box if the BAS Respondent
is the same as the BAS Mailing Contact.

Question 4

Mark (X) this box if the BAS Respondent is
the same as the Highest Elected Official.

CONTACT INFORMATION – Please fill in or correct the contact information below.
BAS Mailing Contact

Mailing
Address

ZIP code

State

Mark (X) one government type for the BAS mailing contact.

(Provide address where BAS materials should be sent.)

Local

County

Regional

Name
Address
Position
Department

City

Telephone

(

)

Fax

(

)

Mailing
Address

Ext.

ZIP code

State
E-mail

Highest Elected Official

Term expiration date:

(for newly incorporated place or newly activated government)

Name
Address
Position
Department
Telephone
Fax

City

(

)

(

)

Ext.

ZIP code

State
E-mail

RETURN FORMS TO:
U.S. Census Bureau
National Processing Center
ATTN: BAS RETURNS, BLDG 63A
1201 East 10th Street
Jeffersonville, IN 47132

Questions?

Telephone: 1-800-972-5651

REMINDER: Sign and date the signature box on all updated map sheets.
Thank you for your participation and timely response.

E-mail: [email protected]

Website: http://www.census.gov/geo/www/bas/bashome.html

CENSUS USE ONLY

SPECIAL INSTRUCTIONS (If any)

FORM BAS-4 (4-30-2008)

Date
processed

Clerk ID
processed

Date
verified

Clerk ID
verified

Date form
keyed

Date GPP
updated

S/S change

S map

Map
change

S/S no
change

O map

Map no
change

PLAT/
Description

Map
signed

Letter

Form Approved: OMB No. 0607-0151; Approval Expires 07-31-10

Question 5

ANNEXATIONS AND DEANNEXATIONS

IMPORTANT – ANNOTATE EACH CHANGE ON THE MAP(S) WITH THE APPROPRIATE DOCUMENTATION.
5a. Have there been any annexations to or deannexations from this incorporated place or newly activated government since the time of
incorporation or activation?
Yes – Please record all annexations and deannexations that have occurred during this period in the Documentation of Changes
section below. Continue with question 5b.
No – Continue with question 5b.
5b. Is the incorporated place legally or physically unable to annex territory?
Yes
No

Documentation of Changes
NEWLY INCORPORATED PLACES AND NEWLY ACTIVATED GOVERNMENTS
Document changes that have occurred since the date of incorporation or activation.
PLACE
CODES

STATE
CODE

BAS ID

Former FIPS

SPECIAL INSTRUCTIONS (If any)

Please follow the instructions below. Print in the spaces provided the information requested for all annexations, deannexations
and other changes that have occurred during the previous year.
Instructions for Entering Data in Columns
(1) Change – Enter A for annexations, D for deannexations, B for boundary correction, or O for other changes.
(2) Authorization – Enter the authorization type. (O=Ordinance, R= Resolution, L = Local Law, S =State-level action, and X = Other)
(3) Date – Enter the effective date of the change. (Month, day, year)
(4) County/Equivalent – Enter the name of the county or equivalent area in which the change occurred.
(5) Area – Enter the estimated size (in tenths of acres) of the annexation, deannexation or other change.
(6) Population/Housing: Enter the estimated current population and number of housing units in each annexed or deannexed area.
Change
Type
A/D/B/O

Authorization
Type
O/R/L/S/X

Date
Month/Day,
Year

County/Equivalent
Name

Area
Acres
(tenths)

Pop/Housing
Population/Housing units

(1)

(2)

(3)

(4)

(5)

(6)

FORM BAS-4 (4-30-2008)

Form Approved: OMB No. 0607-0151; Approval Expires 07-31-10

Documentation of Changes – Continued
NEWLY INCORPORATED PLACES AND NEWLY ACTIVATED GOVERNMENTS
Change
Type
A/D/B/O

Authorization
Type
O/R/L/S/X

Date
Month/Day,
Year

County/Equivalent
Name

Area
Acres
(tenths)

Pop/Housing
Population/Housing units

(1)

(2)

(3)

(4)

(5)

(6)

FORM BAS-4 (4-30-2008)