Phase 4 Form - States with One Congressional District

Enclosure

STATE LEGISLATIVE DISTRICT BOUNDARY

CERTIFICATION FORM

For current state legislative districts, I certify that there have been no changes since the submission of the state legislative districts submitted as part of Phase 4 of the Redistricting Data Program in 2014.

DATE _________________ SIGNATURE __________________________

NAME______________________________________________________________

TITLE______________________________________________________________

ADDRESS___________________________________________________________

E-MAIL_____________________________________________________________

PHONE _____________________________________________________________

FAX ________________________________________________________________

Please contact the Census Redistricting Data Office at 301-763-4039 if you have changes to either plan or questions.

November 2015

Census Redistricting Data Office

U.S. Census Bureau

FAX: 301-763-4348

Email: [email protected]