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BAS-1
(11-16-2016)
U.S. DEPARTMENT OF COMMERCE
Economics and Statistics Administration
U.S. CENSUS BUREAU
BOUNDARY AND ANNEXATION SURVEY (BAS)
INCORPORATED PLACES
Boundaries as of —
To report boundary changes for your incorporated place, please complete this form.
GENERAL
INSTRUCTIONS
• It is important that all questions on the form are answered completely.
• If there are no boundary changes to report, please email [email protected]. call 1–800–972–5651, or respond
electronically at https://www.census.gov/programs-surveys/bas.html.
• Please do not return all of the maps. Sign and return only the maps with changes.
• Return the completed form(s) and updated map(s) using the return label.
• For further instructions on filling out this form, please refer to the BAS Respondent Guide.
State
A. Incorporated place
Type
B. County(ies), parish(es), borough(s), or other statistically
C. Minor civil divisions (code)
equivalent area(s) (code)
BAS ID
Question 1
PLACE
CODES
STATE
CODE
ANSI
FIPS
NAME, TYPE, COUNTY, OR MINOR CIVIL DIVISION CHANGE – Please mark (X) the appropriate boxes.
1a. Are the name and descriptor (i.e., city, town, village, borough) of this incorporated place correct as shown in box A, at
the top of the page?
Effective date of change
Yes – Continue with question 1b.
No – Enter correction here.
Name:
Type:
Date: (Month/Day/Year)
1b. Is the list of the county(ies) or equivalent area(s) and minor civil division(s) within which this incorporated place is
located correct as shown in boxes B and C, at the top of the page?
Yes – SKIP to question 2.
No – Enter correction(s) in question 1c.
1c. Enter the correct information AND the effective date of the change.
Attach additional correction information on a separate sheet.
A – Add
D – Delete
1.
2.
3.
4.
Name of county or equivalent area
Minor civil division
Effective date of change
Month Day
Year
Question 2
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.
State
ZIP code
E-mail
Mark (X) this box if the BAS Respondent is
the same as the BAS Mailing Contact.
Question 3
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.
Mark (X) one government type for the BAS Mailing Contact.
BAS Mailing Contact
Mailing
Address
(Provide address where BAS materials should be sent.)
Local
County
Regional
Name
Address
Position
Department
City
Telephone
(
)
Fax
(
)
Ext.
State
ZIP code
E-mail
Highest Elected Official
Mailing
Address
(for incorporated place only)
Name
Address
Position
Department
City
Telephone
(
)
Fax
(
)
Ext.
ZIP code
State
E-mail
RETURN FORMS TO:
U.S. Census Bureau
National Processing Center
ATTN: BAS RETURNS, BLDG 63E
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: https://www.census.gov/programs-surveys/bas.html
CENSUS USE ONLY
SPECIAL INSTRUCTIONS (If any)
FORM BAS-1 (11-16-2016)
Date
processed
Clerk ID
processed
Date
verified
Clerk ID
verified
Date form
keyed
Date GPP
updated
S/S change
Map received
Map
change
S/S no
change
Other map
Map no
change
PLAT/
Description
Map
signed
Letter
IMPORTANT – ANNOTATE EACH CHANGE ON THE MAP(S) WITH THE APPROPRIATE DOCUMENTATION
ACCORDING TO THE INSTRUCTIONS PROVIDED IN THE BAS RESPONDENT GUIDE.
Please update the map(s) USING THE APPROPRIATE COLORED PENCILS.
Question 4
LEGAL BOUNDARY CHANGES – Please mark (X) the applicable box(es).
Time period
4a. Have there been any legal boundary changes to this incorporated place during the time period shown above?
Yes – Please record all legal changes (annexations, deannexations, and other actions) in the Documentation of Changes
section of this form and update the map(s) USING THE ENCLOSED RED PENCIL. Continue with question 4b.
No – Continue with question 4b.
4b. Are there any legal boundary changes that occurred before the period shown above that do not appear on the enclosed map(s)?
Yes – Please record all legal changes (annexations, deannexations, and other actions) in the Documentation of Changes
section of this form and update the map(s) USING THE ENCLOSED RED PENCIL. Continue with question 4c.
No – Continue with question 4c.
4c. Has your incorporated place had any other types of changes (i.e. consolidations/mergers, been annexed, been
dissolved/disincorporated, etc.) that have affected its boundaries or governmental status during the time period shown above?
No – SKIP to question 5.
Yes – Complete question 4d.
4d. This place has: Mark (X) one of
(Month/Day/Year)
Ordinance/Resolution No.
Government
the following
Name of government with which place consolidated/merged
(1)
consolidated/merged with
Number
. . . .
Name of government annexing this incorporated place
(2)
Date
Number
been annexed by . . . . . . . . . .
Name of government being dissolved/disincorporated
(3)
dissolved/disincorporated
Date
Date
Number
. . . .
Date
(4)
Number
Other – Provide an explanation.
Question 5
OTHER CHANGES – Mark (X) applicable box(es).
5a. Besides legal changes, are there any boundary corrections that need to be made to your boundary on the map(s)?
Yes – Please correct the map(s) USING THE ENCLOSED RED PENCIL and the letters "BC" to indicate a boundary correction.
Enter the total number of boundary corrections that you made to the maps.
Continue with question 5b.
No – Continue with question 5b.
5b. Did you add, delete, or make any changes to the features (other than boundaries) shown on the map(s)?
Yes – Correct the map(s) USING THE ENCLOSED PURPLE PENCIL. Continue with question 5c.
No – Continue with question 5c.
5c. Did you make any changes to the addresses shown on the map(s)?
Yes – Correct the map(s) USING THE ENCLOSED PURPLE PENCIL.
No
REMINDER: Sign and date the signature box on all updated map sheets.
FORM BAS-1 (11-16-2016)
Documentation of Changes
INCORPORATED PLACES
Incorporated place
Type
PLACE
CODES
STATE
CODE
BAS ID
State
FIPS
ANSI
SPECIAL INSTRUCTIONS (If any)
Please follow the instructions below and review the preprinted entries for correctness and completeness and make changes as
necessary. For new legal changes, use the provided spaces to print the requested information requested for all annexations,
deannexations, and other changes that have occurred during the previous year(s).
Instructions for Entering Data in Columns
(1) Change – Enter A for annexations, D for deannexations, B for boundary corrections, 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) Authorization – Enter the authorization number for the change you are reporting.
(4) Date – Enter the effective date of the change. (Month, day, year)
(5) County/Equivalent – Enter the name of the county or equivalent area in which the change occurred.
(6) Minor Civil Division – Enter the name of the minor civil division (if any) in which the change occurred.
(7) Area – Enter the estimated size (in tenths of acres) of the annexation, deannexation or other change.
Authorization
Change
Type
A/D/O
Type
O/R/L/S/X
Authorization
Number
Date
Month/Day
Year
County/Equivalent
Name
Minor Civil Division
Name (if any)
Area
Acres
(Tenths)
(1)
(2)
(3)
(4)
(5)
(6)
(7)
If additional space is needed, please use the BAS-1 "Documentation of Changes" form
found in the BAS Respondent Guide.
FORM BAS-1 (11-16-2016)
BAS-1
Documentation of Changes – Continued
FORM
(11-16-2016)
INCORPORATED PLACES
Incorporated place
U.S. DEPARTMENT OF COMMERCE
Economics and Statistics Administration
U.S. CENSUS BUREAU
State
Type
STATE
CODE
BAS ID
PLACE
CODES
ANSI
FIPS
SPECIAL INSTRUCTIONS (If any)
Authorization
Change
Type
A/D/O
Type
O/R/L/S/X
Authorization
Number
(1)
(2)
(3)
Date
Month/Day,
Year
County/Equivalent
Name
Minor Civil Division
Name (if any)
Area
Acres
(Tenths)
(4)
(5)
(6)
(7)
FORM
BAS-2
(11-15-2016)
U.S. DEPARTMENT OF COMMERCE
Economics and Statistics Administration
U.S. CENSUS BUREAU
BOUNDARY AND ANNEXATION SURVEY (BAS)
COUNTIES AND EQUIVALENT AREAS
Boundaries as of —
GENERAL
INSTRUCTIONS
To report changes for your county, parish, borough or equivalent area, please complete this form.
• It is important that all questions on the form are answered completely.
• If there are no boundary changes to report, please email [email protected], call 1–800–972–5651, or respond
electronically at https://www.census.gov/programs-surveys/bas.html.
• Please do not return all of the maps. Sign and return only the maps with changes.
• Return the completed form(s) and updated map(s) using the preaddressed envelope or return label.
• For further instructions on filling out this form, please refer to the BAS Respondent Guide.
Type
County, parish, borough or equivalent area
STATE CODE
BAS ID
State
COUNTY CODE
IMPORTANT – ANNOTATE EACH CHANGE ON THE MAP(S) WITH THE APPROPRIATE DOCUMENTATION ACCORDING TO THE
INSTRUCTIONS PROVIDED IN THE BAS RESPONDENT GUIDE. Please update the map(s) USING THE APPROPRIATE COLORED PENCILS.
Question 1
LEGAL COUNTY BOUNDARY CHANGES DURING THIS PERIOD
Please mark (X) the appropriate boxes.
1a. Have there been any legal boundary changes to this county, parish, borough or equivalent area during the time period shown above?
Yes – Please record all legal changes (annexations, deannexations, and other actions) in the Documentation of Changes
section of this form and update the map(s) USING THE ENCLOSED RED PENCIL. Continue with question 1b.
No – Continue with question 1b.
1b. Are there any legal boundary changes to the county, parish, borough or equivalent area that occurred prior to the time period shown
for question 1, but do not appear on the enclosed maps?
Yes – Please update the map(s) with the RED PENCIL. Continue with question 1c.
No – Continue with question 1c.
1c. Besides legal changes, are there any boundary corrections that need to be made to your boundary on the map(s)?
Yes – Correct the map(s) USING THE RED PENCIL and the letters "BC" to indicate a boundary correction.
Enter the total number of boundary corrections that were
made to the county or equivalent area’s boundary.
Continue with question 1d.
No – Continue with question 1d.
1d. Is your county a consolidated BAS respondent? If you are unfamiliar with this approach, please consult your BAS Respondent Guide.
Yes – Continue with question 2.
No – Please encourage the MCD and/or incorporated place BAS respondents in your county, parish, borough or equivalent
area to report their changes. Continue with question 2d.
Question 2
OTHER CHANGES – Mark (X) applicable box(es).
2a. Have there been any legal boundary changes to the minor civil divisions or incorporated places (if any) within this county,
parish, borough or equivalent area during the time period shown for question 1, above?
Yes – Please update the map(s) with the RED PENCIL. Continue with question 2b.
No – Continue with question 2b.
2b. Are there any legal boundary changes to the minor civil divisions or incorporated places (if any) that occurred prior to the
time period shown for question 1, but do not appear on the enclosed maps?
Yes – Please update the map(s) with the RED PENCIL. Continue with question 2c.
No – Continue with question 2c.
2c. Are there any corrections that should be made to the boundaries shown on the map(s) of your minor civil divisions (MCDs) or
incorporated places?
Yes – Please update the map(s) with the RED PENCIL and the letters "BC" to indicate a boundary correction.
Enter the total number of boundary corrections that
were made to MCDs and incorporated places.
Continue with question 2d.
No – Continue with question 2d.
2d. Do you wish to report any additions, deletions or other changes to the features (other than boundaries) shown on the map(s)?
Yes – Please update the map(s) with the PURPLE PENCIL. Continue with question 3.
No – Continue with question 3.
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/equivalent
Regional
Name
Address
Position
Department
City
Telephone
(
)
Fax
(
)
Ext.
State
ZIP code
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.
Mark (X) one government type for the BAS Mailing Contact.
BAS Mailing Contact
Mailing
Address
(Provide address where BAS materials should be sent.)
Local
County/equivalent
Regional
Name
Address
Position
Department
City
Telephone
(
)
Fax
(
)
Ext.
State
ZIP code
E-mail
Highest Elected Official
Mailing
Address
(for county, parish, borough or equivalent area)
Name
Address
Position
Department
City
Telephone
(
)
Fax
(
)
Ext.
State
ZIP code
E-mail
RETURN FORMS TO:
U.S. Census Bureau
National Processing Center
ATTN: BAS RETURNS, BLDG 63E
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: https://www.census.gov/programs-surveys/bas.html
CENSUS USE ONLY
SPECIAL INSTRUCTIONS (If any)
FORM BAS-2 (11-15-2016)
Date
processed
Clerk ID
processed
Date
verified
Clerk ID
verified
Date form
keyed
Date GPP
updated
S/S change
Map received
Map
change
S/S no
change
Other map
Map no
change
PLAT/
Description
Map
signed
Letter
GOVERNMENT NAMES AND STATUS DOCUMENTATION
COUNTIES AND EQUIVALENT AREAS
County, parish, borough or equivalent area
BAS ID
Type
State
STATE CODE
COUNTY CODE
SPECIAL INSTRUCTIONS (If any)
Other (merger,
consolidation, etc.)
(1)
Inactive entity
became active
• Correct the spelling only
• Do not enter a date in column (9).
Active entity
became inactive
If the name shown is misspelled —
• Draw a line through it,
• Print the correct type
above it, and
• Enter the date the change
was effective in column (9).
Incorporated place or
MCD never existed
• Draw a line through it,
• Print the correct type above it, and
• Enter the date the change was effective in column (9).
If the type shown is
incorrect —
STATUS CHANGES
If changes in status have
occurred — Please mark (X)
in the appropriate column
and enter the date the
change was effective in (9).
Disincorporated place
or disorganized MCD
If the name shown has changed —
TYPE
New incorporated place
or organized MCD
NAME OF INCORPORATED PLACE OR
MINOR CIVIL DIVISION (MCD)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
Refer to the BAS Respondent Guide for instructions on filling out this table.
FORM BAS-2 (11-15-2016)
EFFECTIVE
DATE OF
CHANGE
Month, day,
year
(9)
GOVERNMENT NAMES AND STATUS DOCUMENTATION – Continued
COUNTIES AND EQUIVALENT AREAS
County or
equivalent
areaor(ifequivalent
any)
County,
parish,
borough
area
BAS ID
Type
State
STATE CODE
Other (merger,
consolidation, etc.)
(2)
Inactive entity
became active
(1)
Active entity
became inactive
If the name shown is misspelled —
• Correct the spelling only
• Do not enter a date in column (9).
Incorporated place or
MCD never existed
• Draw a line through it,
• Print the correct name above it, and
• Enter the date the change was effective in column (9).
If the type shown is
incorrect —
• Draw a line through it,
• Print the correct type
above it, and
• Enter the date the change
was effective in column (9).
STATUS CHANGES
If changes in status have
occurred — Please mark (X)
in the appropriate column
and enter the date the
change was effective in (9).
Disincorporated place
or disorganized MCD
If the name shown has changed —
TYPE
New incorporated place
or organized MCD
NAME OF INCORPORATED PLACE OR
MINOR CIVIL DIVISION
COUNTY CODE
(3)
(4)
(5)
(6)
(7)
(8)
EFFECTIVE
DATE OF
CHANGE
Month, day,
year
If additional space is needed, please use the BAS-2 "Government Names and Status Documentation" form
found in the BAS Respondent Guide.
FORM BAS-2 (11-15-2016)
(9)
Documentation of Changes
COUNTIES AND EQUIVALENT AREAS
County, parish, borough or equivalent area
Type
BAS ID
STATE CODE
State
COUNTY CODE
SPECIAL INSTRUCTIONS (If any)
Please follow the instructions below and review the preprinted entries for correctness and completeness and make changes as
necessary. For new legal changes, use the provided spaces to print the requested information for all annexations, deannexations and
other changes that have occurred during the previous year(s).
Instructions for Entering Data in Columns
(1) Change – Enter A for annexations, D for deannexations, B for boundary corrections, 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) Authorization – Enter the authorization number for the change you are reporting.
(4) Date – Enter the effective date of the change. (Month, day, year)
(5) Entity – Enter the name of the entity (i.e. name of MCD, place, or county) where the change occurred.
(6) County/Equivalent – Enter the name of the county or equivalent area in which the change occurred.
(7) Minor Civil Division (MCD) – Enter the name of the minor civil division (if any) in which the change occurred.
(8) Area – Enter the estimated size (in tenths of acres) of the annexation, deannexation or other change.
Change
Type
A/D/O
(1)
Authorization
Type
O/R/L/S/X
(2)
FORM BAS-2 (11-15-2016)
Authorization
Number
(3)
Date
Month/Day,
Year
Entity
Name
County/
Equivalent
Name
(4)
(5)
(6)
Minor Civil Division
Name (if any)
(7)
Area
Acres
(tenths)
(8)
Documentation of Changes – Continued
COUNTIES AND EQUIVALENT AREAS
County, parish, borough or equivalent area
Type
BAS ID
Change
Type
A/D/O
(1)
STATE CODE
Authorization
Type
O/R/L/S/X
(2)
Authorization
Number
(3)
State
COUNTY CODE
Date
Month/Day,
Year
Entity
Name
County/
Equivalent
Name
(4)
(5)
(6)
Minor Civil Division
Name (if any)
(7)
If additional space is needed, please use the BAS-2 "Documentation of Changes" form
found in the BAS Respondent Guide.
FORM BAS-2 (11-8-2016)
Area
Acres
(tenths)
(8)
FORM
BAS-3
(1-31-2017)
U.S. DEPARTMENT OF COMMERCE
Economics and Statistics Administration
U.S. CENSUS BUREAU
BOUNDARY AND ANNEXATION SURVEY (BAS)
MINOR CIVIL DIVISIONS (MCD)
Boundaries as of —
To report changes to your entity, please complete this form.
• It is important that all questions on the form are answered completely.
• If there are no boundary changes to report, please email geo.bas@census,gov, call 1–800–972–5651, or respond
electronically at https://www.census.gov/programs-surveys/bas.html.
• Please do not return all of the maps. Sign and return only the maps with changes.
• Return the completed form(s) and updated map(s) using the return label.
• For further instructions on filling out this form, please refer to the BAS Respondent Guide.
GENERAL
INSTRUCTIONS
Type
A. Minor civil division
STATE
CODE
BAS ID
County
MCD
CODES
COUNTY
CODE
State
ANSI
FIPS
IMPORTANT – ANNOTATE EACH CHANGE ON THE MAP(S) WITH THE APPROPRIATE DOCUMENTATION ACCORDING TO THE
INSTRUCTIONS PROVIDED IN THE BAS RESPONDENT GUIDE. Please update the map(s) USING THE APPROPRIATE COLORED PENCILS.
Question 1
NAME OR TYPE CHANGE – Please mark (X) the applicable boxes.
1a. Are the name and type (i.e. town, township, plantation, location, Reservation) correct as shown in Box A at the top of the page?
Yes – Continue with question 2.
Effective date of change
Date (Month/Day/Year)
Type
Name
No – Enter correction here.
Question 2
LEGAL BOUNDARY CHANGES – Please mark (X) the applicable boxes.
Time period:
2a. Have there been any legal boundary changes to this minor civil division during the time period shown above?
Yes – Please record all legal change actions (annexations, deannexations and other actions) in the Documentation of Changes
section of the form and update the map(s) USING THE ENCLOSED RED PENCIL. Continue with question 2b.
No – Continue with question 2b.
2b. Has your minor civil division had any other types of changes (i.e. consolidations/mergers, been annexed, been
dissolved/disincorporated, etc.) that have affected its boundaries or governmental status during the time period shown above?
Yes – Complete question 2c.
2c. This MCD has: Mark (X) one of the
following
No – SKIP to question 2d.
Government:
Enter the effective date of change and
the Ordinance or Resolution Number:
(Month/Day/Year)
Ordinance/Resolution No.
Name of government with which minor civil division consolidated/merged Date/Number
(1)
(2)
(3)
consolidated/merged with . . . . .
Name of government annexing this minor civil division
Date/Number
Name of government being dissolved/disincorporated
Date/Number
been annexed by . . . . . . . . . . .
dissolved/disincorporated . . . . .
Date/Number
(4)
Other – Provide an explanation.
2d. Are there any legal boundary changes that occurred before the period shown above that do not appear on the enclosed map(s)?
Yes – Please make the necessary updates to the map(s). Continue with question 3.
Question 3
No – Continue with question 3.
OTHER CHANGES – Please mark (X) the applicable boxes.
3a. Besides legal changes, are there any boundary corrections that need to be made to your boundary on the map(s)?
Yes – Please correct the map(s) USING THE ENCLOSED RED PENCIL and the initials BC to indicate a boundary correction.
Enter the total number of boundary corrections that you made to the maps.
No – Continue with question 4.
Continue with question 4.
Question 4
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.
State
ZIP code
E-mail
Mark (X) this box if the BAS Respondent
is the same as the BAS Mailing Contact.
Question 5
Mark (X) this box if the BAS Respondent is
the same as the Highest Elected Official.
CONTACT INFORMATION – Please fill in or correct the content information below.
Mark (X) one government type for the BAS mailing contact.
BAS Mailing Contact
Mailing
Address
(Provide address where BAS materials should be sent.)
Local
County
Regional
Name
Address
Position
Department
City
Telephone
(
)
Fax
(
)
Ext.
State
ZIP code
E-mail
Highest Elected Official
Mailing
Address
(for MCD only)
Name
Address
Position
Department
City
Telephone
(
)
Fax
(
)
Ext.
State
ZIP code
E-mail
RETURN FORMS TO:
U.S. Census Bureau
National Processing Center
ATTN: BAS RETURNS, BLDG 63E
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: https://www.census.gov/programs-surveys/bas.html
CENSUS USE ONLY
SPECIAL INSTRUCTIONS (If any)
FORM BAS-3 (1-31-2017)
Date
processed
Clerk ID
processed
Date
verified
Clerk ID
verified
Date form
keyed
Date GPP
updated
S/S change
Map received
Map
change
S/S no
change
Other map
Map no
change
PLAT/
Description
Map
signed
Letter
Documentation of Changes
MINOR CIVIL DIVISIONS
Minor civil division
Type
STATE
CODE
BAS ID
County
COUNTY
CODE
MCD
CODES
State
ANSI
FIPS
SPECIAL INSTRUCTIONS (If any)
Please follow the instructions below to review the preprinted entries for correctness and completeness and make changes as
necessary. For new legal changes, use the provided spaces to print the requested information all annexations, deannexations and
other changes that have occurred during the previous year(s).
Instructions for Entering Data in Columns
(1) Change – Enter A for annexations, D for deannexations, B for boundary corrections, 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) Authorization – Enter the authorization number for the change you are reporting.
(4) Date – Enter the effective date of the change. (Month, day, year)
(5) Minor Civil Division (MCD) – Enter the name of the minor civil division in which the change occurred.
(6) Area – Enter the estimated size (in tenths of acres) of the annexation, deannexation or other change.
Change
Type
A/D/O
(1)
FORM BAS-3 (1-31-2017)
Authorization
Type
O/R/L/S/X
(2)
Authorization
Number
(3)
Date
Month/Day,
Year
Minor Civil Division
Name
Area
Acres
(tenths)
(4)
(5)
(6)
Documentation of Changes – Continued
MINOR CIVIL DIVISIONS
Minor civil division
Type
STATE
CODE
BAS ID
County
COUNTY
CODE
MCD
CODES
State
ANSI
FIPS
SPECIAL INSTRUCTIONS (If any)
Change
Type
A/D/O
(1)
Authorization
Type
O/R/L/S/X
(2)
Authorization
Number
(3)
Date
Month/Day,
Year
Minor Civil Division
Name
Area
Acres
(tenths)
(4)
(5)
(6)
If additional space is needed, please use the BAS-3 "Documentation of Changes" form found
in the BAS Respondent Guide.
FORM BAS-3 (11-15-2016)
FORM
BAS-5
(11-17-2016)
U.S. DEPARTMENT OF COMMERCE
Economics and Statistics Administration
U.S. CENSUS BUREAU
BOUNDARY AND ANNEXATION SURVEY (BAS)
AMERICAN INDIAN RESERVATIONS AND OFF-RESERVATION TRUST LAND
Boundaries as of —
GENERAL
INSTRUCTIONS
To report changes for your American Indian Area (AIA), please complete this form.
• It is important that all questions on the form are answered completely.
• If there are no boundary changes to report, please email [email protected], call 1–800–796–3748, or respond
electronically at https://www.census.gov/programs-surveys/bas.html.
• Please do not return all of the maps. Sign and return only the maps with changes.
• Return the completed form(s) and updated map(s) using the return label.
• For further instructions on filling out this form, please refer to the BAS Respondent Guide.
American Indian reservation/off-reservation trust land name
CENSUS
CODE
BAS ID
Question 1
ANSI
CODE
NAME CHANGE – Please mark (X) the applicable boxes.
1a. Is the name of this American Indian reservation/off-reservation trust land correct as shown above?
Please provide supporting documentation:
(Refer to the BAS Respondent Guide for instructions.)
Yes – Continue with question 2.
No – Enter correction here.
Continue with question 2.
Question 2
Mailing
Address
Name
Effective date of change
Date (Month/Day/Year)
CONTACT INFORMATION – Please fill in your contact information in the space provided below.
BAS Respondent
(The BAS Respondent is the person filling out this form.)
Name
Address
Position
Department
City
Telephone
(
)
Fax
(
)
Ext.
State
E-mail
Mark (X) this box if the BAS Respondent is
the same as the BAS Mailing Contact.
Question 3
Mailing
Address
ZIP code
Mark (X) this box if the BAS Respondent
is the same as the Tribal Chair.
CONTACT INFORMATION – Please fill in or correct the contact information below.
BAS Mailing Contact
(Provide address where BAS materials should be sent.)
Name
Address
Position
Department
City
Telephone
(
)
Fax
(
)
Mailing Address
Ext.
State
ZIP code
E-mail
Tribal Chair
Name
Address
Position
Department
City
Telephone
(
)
Fax
(
)
Ext.
State
E-mail
ZIP code
RETURN FORMS TO:
REMINDER: Sign and date the signature box on all updated map sheets.
U.S. Census Bureau
National Processing Center
ATTN: BAS Returns, Building 63E
1201 East 10th Street
Jeffersonville, IN 47132
Thank you for your participation and timely response.
QUESTIONS?
For further information:
Telephone:
E-mail:
[email protected]
Website:
https://www.census.gov/programs-surveys/bas.html
SPECIAL INSTRUCTIONS (If any)
*If you have tribal subdivision changes, please return your paper forms.
Please check appropriate box.
Tribal Governing Body Type:
Federal
Traditional
Self-Governance
Other
IMPORTANT – PLEASE REVIEW THE ENCLOSED MAPS AND ANNOTATE EACH CHANGE ON THE MAP(S)
WITH THE APPROPRIATE DOCUMENTATION ACCORDING TO THE INSTRUCTIONS PROVIDED IN THE
BAS RESPONDENT GUIDE.
Update the map(s) USING THE APPROPRIATE COLORED PENCILS.
You must provide supporting documentation such as a trust deed or court order when submitting legal
boundary changes.
CENSUS USE ONLY
Date processed
Clerk ID processed
S/S change
Map received
Map
change
Date verified
Clerk ID verified
S/S no
change
Other map
Map no
change
Date form keyed
Date GPP updated
PLAT/
Description
Map
signed
Letter
FORM BAS-5 (11-17-2016)
BAS-5
FORM
(11-17-2016)
Question 4
LEGAL BOUNDARY AND OTHER CHANGES – Please mark (X) the applicable box(es).
Time period
4a. Were there any additions or deletions of any reservation or off-reservation trust land areas during the time period shown above?
(Include legal changes such as changing the status of land from off-reservation trust land to reservation land. Please refer to the
BAS Respondent Guide for a description of legal boundary changes.)
Yes – Record all legal changes (additions, deletions and other changes) in the Documentation of Changes section of the
form and update the map(s) USING THE ENCLOSED RED PENCIL.
Provide supporting documentation for each change (i.e. trust deed or court order). Continue with question 4b.
No – Continue with question 4b.
4b. Were there any additions or deletions of any reservation or off-reservation trust land areas before the time period shown above
that do not appear on the enclosed maps?
(Include legal changes such as changing the status of land from off-reservation trust land to reservation land.)
Yes – Record all legal changes (additions, deletions and other changes) in the Documentation of Changes section of
the form and update the map(s) USING THE ENCLOSED RED PENCIL. Provide supporting documentation for
each change (i.e. trust deed or court order). Continue with question 4c.
No – Continue with question 4c.
4c. Besides legal changes, are there any boundary corrections that need to be made to your boundary on the map(s)?
Yes – Please correct the map(s) USING THE ENCLOSED RED PENCIL and the initials BC to indicate a boundary correction.
Enter the total number of boundary corrections.
Continue with question 4d.
No – Continue with question 4d.
4d. Did you add, delete, or modify any tribal subdivision areas?
(Include changes to name, type and/or status as well as boundary changes.)
Yes – Complete the Tribal Names and Status Documentation Section of the form. Continue with question 4e.
No – Continue with question 4e.
4e. Did you change, add or delete any roads, streams/rivers, or any other physical features on the map(s)?
Yes – Correct the map(s) according to the instructions provided in the BAS Respondent Guide. Continue with question 4f.
No – Continue with question 4f.
4f. Did you change, add or delete any of the address ranges shown at the reservation and/or off-reservation trust land
boundary, or add any address ranges for boundary changes you made to the map(s)?
Yes – Correct the map(s) according to the instructions provided in the BAS Respondent Guide.
No
REMINDER: Sign and date the signature box on all updated map sheets.
For further information: https://www.census.gov/programs-surveys/bas.html
Documentation of Changes
AMERICAN INDIAN RESERVATIONS AND OFF-RESERVATION TRUST LAND
American Indian reservation/off-reservation trust land name
CENSUS
CODE
BAS ID
CODE
ANSI
Please follow the instructions below and review the preprinted entries for correctness and completeness. Print in the space provided the
information requested for all additions, deletions and other changes that have occurred during the previous year.
Instructions for Entering Data in Columns
(1) Change – Enter A for additions, D for deletions, B for boundary corrections, or O for other changes.
(2) Authorization (Type) – Enter the authorization type. (A = Act of Congress, Statute, or Federal Law. C = Federal Court decision,
D = Deed placing land into trust, and N = Federal Register notice or notice published in a local newspaper by the federal
government, or X = Other)
(3) Authorization (Identifying Number) – Enter the identifying number for the change you are reporting.
(4) Date – Enter the effective date of the change. (Month, day, year)
(5) Land – Enter the type of land added. (R = reservation or T = off-reservation trust land)
(6) County/Equivalent – Enter the name of the county or equivalent area in which the change occurred.
(7) Area – Enter the estimated size (in tenths of acres) of the addition, deletion or other change.
Change
Type
A/D/B/O
(1)
Authorization
Type
A/C/D/N/X
(2)
Identifying Number
(If any)
Date
Month/Day
Year
Land
Type
R/T
County/Equivalent
Name
Area
Acres
(Tenths)
(3)
(4)
(5)
(6)
(7)
If additional space is needed, please use the BAS-5 "Documentation of Changes" form
found in the BAS Respondent Guide.
FORM BAS-5 (11-17-2016)
Documentation of Changes – Continued
AMERICAN INDIAN RESERVATIONS AND OFF-RESERVATION TRUST LAND
American Indian reservation/off-reservation trust land name
CENSUS
CODE
BAS ID
Change
Type
A/D/B/O
(1)
Authorization
Type
A/C/D/N/X
(2)
FORM BAS-5 (11-16-2016)
Identifying Number
(If any)
(3)
CODE
ANSI
Date
Month/Day,
Year
Land
Type
R/T
County/Equivalent
Name
Area
Acres
(tenths)
(4)
(5)
(6)
(7)
Tribal Names and Status Documentation
TRIBAL SUBDIVISIONS
American Indian reservation/off-reservation trust land name
CENSUS
CODE
BAS ID
ANSI
CODE
Tribal Subdivisions as of
Listed below are all of the tribal subdivisions in the U.S. Census Bureau records that have been submitted by your tribal
government for your reservation and/or off-reservation trust land. Tribal subdivisions are units of self-government or
administration within reservation and/or trust land boundaries that serve social, economic, cultural, or legal purposes and may be
designated as districts, communities, chapters, precincts, etc.
If your tribal government previously submitted tribal subdivisions to the U.S. Census Bureau, please review the list of tribal
subdivisions below and make any necessary changes to the name, type, status or date. Active, legal subdivisions are defined as
having a functioning government with elected officials that provides services within the subdivision. Inactive subdivisions have no
functioning government or elected officials and receive services solely from the tribe. Tribal government resolutions or ordinances
must accompany any changes as supporting documentation. If you would like to delineate a tribal subdivision for the first time,
please refer to the BAS Respondent Guide for instructions.
To report additions, deletions, modifications and/or boundary changes to existing tribal subdivisions, please update both the list
below and the enclosed map(s). You may make changes to the maps with the BLUE pencil that is provided. Please refer to your
BAS Respondent Guide for more information.
(2)
Boundary
correction
the type shown is incorrect —
Please draw a line through it,
Print the correct type above it, and
Enter the date the change was
effective in column (8). if applicable.
Legal
boundary
change
If
•
•
•
Subdivision
never
existed
Is this an active [A] or inactive [I]
subdivision? (See definitions above.)
STATUS CHANGES
If changes in status have occurred:
mark (X) the appropriate column
and enter the effective date in
EFFECTIVE
column (8).
DATE
Deleted
subdivision
(1)
TYPE
New
subdivision
OFFICIAL NAME OF TRIBAL
SUBDIVISION
If the name shown has changed —
• Please draw a line through it,
• Print the correct name above it, and
• Enter the date the change was effective
in column (8).
If the name is misspelled —
• Please correct the spelling only.
• Do not enter a date in column (8).
(3)
(4)
(5)
(6)
(7)
Month, day,
year
If additional space is needed, please use the BAS-5 "Tribal Names and Status Documentation" form
found in the BAS Respondent Guide.
FORM BAS-5 (11-16-2016)
(8)
Tribal Names and Status Documentation – Continued
TRIBAL SUBDIVISIONS
American Indian reservation/off-reservation trust land name
CENSUS
CODE
FORM BAS-5 (11-16-2016)
the type shown is incorrect —
Please draw a line through it,
Print the correct type above it, and
Enter the date the change was
effective in column (8). if applicable
(2)
Boundary
correction
If
•
•
•
Legal
boundary
change
Is this an active [A] or inactive [I]
subdivision? (See definitions above.)
STATUS CHANGES
If changes in status have occurred
mark (X) the appropriate column
and enter the effective date in
column (8).
Subddivision
never
existed
(1)
TYPE
ANSI
Deleted
subdivision
OFFICIAL NAME OF TRIBAL
SUBDIVISION
If the name shown has changed —
• Please draw a line through it,
• Print the correct name above it, and
• Enter the date the change was effective
in column (8).
If the name is mispelled —
• Please correct the spelling only.
• Do not enter a date in column (8).
CODE
New
subdivision
BAS ID
(3)
(4)
(5)
(6)
(7)
EFFECTIVE
DATE
Month, day,
year
(8)
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
U.S. DEPARTMENT OF COMMERCE
Economics and Statistics Administration
R
EA
S
BU
US
CE
ER
U.S.
D
ENT OF C
TM
OM
AR
M
EP
U.S. CENSUS BUREAU
EN
U O
F TH E C
2018
BOUNDARY AND ANNEXATION SURVEY
ANNUAL RESPONSE AND CONTACT UPDATE FORM
BAS-ARF
FORM
(9-25-2017)
OMB No. 0607-0151 Approval Expires: 03/31/2019
Please respond to the BAS using this form or online at https://www.census.gov/geo/partnerships/bas/bas_ar_form.html
For more information on the BAS, visit the BAS website at https://www.census.gov/programs-surveys/bas.html
Mark (X) one box.
Our government does not have boundary changes to report.
Our government HAS boundary changes to report OR I would like to use one of the following options to review and
update my government’s boundaries. Please mark one of the next three boxes.
We will download the Geographic Update Partnership Software (GUPS) OR we will download
shapefiles only.
Please send the Geographic Update Partnership Software (GUPS) and shapefiles on DVD.
Please send Paper Maps.
CONTACT INFORMATION: BAS materials will be mailed to the Highest Elected Official (HEO) or Tribal
Chair (TC) if there is no BAS contact information printed below. If you prefer to have your BAS materials shipped
directly to a person responsible for updating your boundaries, provide the contact information in the space
below. Please use black ink to correct any preprinted information.
Our records indicate the HEO/TC contact is:
Name of person filling out this form
To save nonresponse follow-up
costs, respond online, email,
mail, or fax the form to the
U.S. Census Bureau within 10
calendar days.
Our records indicate the BAS contact is:
Position
U.S. Census Bureau
National Processing Center
1201 East 10th Street, BLDG 63E
Jeffersonville, IN 47132-0001
Fax Number: 1–800–972–5652
Date
E-mail questions/comments to:
[email protected];
use "BAS-ARF" as the subject.
Phone: 1–800–972–5651
| File Type | application/pdf |
| File Modified | 2017-12-19 |
| File Created | 2017-12-19 |