BC-658(L) "Insufficient Information Received to Proceed with Searc

ATTCHMENT D
FORM BC-658(L)
(9-23-2005)

OMB No. 0607-0117:

DC

UNITED STATES DEPARTMENT OF COMMERCE
Economics and Statistics Administration

U.S. Census Bureau
National Processing Center
Jeffersonville, IN 47132-0001

•

Re:

Before a search can be made of the census records, it will be necessary for you to furnish us with the
exact address of the head of household with whom you were living on the following date:

If living in a city at the time for the census, it will be necessary to furnish the house number, name of
the street, city, county, and State, If residing in a rural area, it is very important to provide the
township, district, precinct or beat and the direction and number of miles from the nearest town.
Please enter the information in the spaces provided below or on the reverse side if additional space is
needed and return it to Personal Census Search Unit, PO Box 1545, Jeffersonville, IN 47131-0001. If
the information requested is not received within 90 days, this case will be closed.

Census
date
(a)

Number and street
(b)

City or town

County and State

Name of person
with whom living
(head of household)

(c)

(d)

(e)

JAN 1,
1920*
APRIL 1,
1930
APRIL 1,
1940
APRIL 1,
1950
APRIL 1,
1960
APRIL 1,
1970
APRIL 1,
1980
APRIL 1,
1990

ZIP Code:

APRIL 1,
2000

ZIP Code:

*Census dated 1920 may be searched if you give only the name of the city, county, State of residence, and the name of the household head on the
census date. However, a more complete address is helpful if extensive searching is required. For all other census listed, it is necessary to give your
exact place of residence on the census date.

USCENSUSBUREAU
Helping You Make Informed Decisions

www.census.gov

The average time it should take you to fill out the BC-658, "Insufficient Information Received to Proceed with Search,"
including the time spent reading instructions is 6 minutes.
If you have any questions regarding this estimate or any other aspect of this form, send comments regarding this burden
estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to: Paperwork
Project 0607-0117, U.S. Census Bureau, 4700 Silver Hill Road, Stop 1500, Washington, D.C. 20233-1500. You may e-mail
comments to "[email protected]; use "Paperwork Project 0607-0117" as the subject.
Respondents are not required to respond to any information collection unless it displays a valid approval number from the
Office of Management and Budget. This 8-digit number appears in the top left corner on the front of this form.

FORM BC-658(L) (9-23-2005)