BAS-6 Boundary & Annexation Survey, Consolidated BAS

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
GENERAL
INSTRUCTIONS

To sign up for the Consolidated BAS (C-BAS) program, please complete this form.
• It is important that all questions on the form are answered completely.
• 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 [email protected].

Name of county, parish, borough or equivalent area

COUNTY CODE

STATE CODE

BAS ID
Section 1

State

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

Name:

Address:

Position:
Department:

City:

Telephone:

(

)

–

Fax:

(

)

–

Ext:

ZIP code

State:
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
BAS ID

PARTICIPATION ROSTER
Entity Name

Agreed?
Y/N

Contact Name

Position

Telephone Number

Date of
Contact

Section 2
BAS ID

FORM BAS-6 (10-12-2011)

PARTICIPATION ROSTER – Continued
Entity Name

Agreed?
Y/N

Contact Name

Position

Telephone Number

Date of
Contact

Section 2
BAS ID

FORM BAS-6 (10-12-2011)

PARTICIPATION ROSTER – Continued
Entity Name

Agreed?
Y/N

Contact Name

Position

Telephone Number

Date of
Contact