Form D-2001 Contact Information Update Form

Form D-2001 (XX-XX-XXXX) OMB Control No. XXXX-XXXX

U.S. DEPARTMENT OF COMMERCE ECONOMICS AND STATISTICS ADMINSTRATION U.S. CENSUS BUREAU

CONTACT INFORMATION UPDATE FORM 2020 CENSUS LOCAL UPDATE OF CENSUS ADDRESSES OPERATION (LUCA)	ENITIY ID:
	Government Name:
	Contact ID:

The person listed in Section A is associated by the Census Bureau as an organizational or program contact for the government listed above, as indicated by the mark in box or boxes below:

 Highest Elected/Appointed Official  Appointed Regional Agency Planner

 Tribal Chair  2010 LUCA Liaison

 Governor’s Liaison  Geographic Support System Contact

 Census Contact Liaison  Federal State Cooperative for Population Estimates Contact

 State Data Center Contact  National States Geographic Information Council Contact

 GIS Contact  Addressing Authority Contact

 Boundary and Annexation Survey Contact

Please indicate the status of the information in Section A by checking the appropriate box:

 Section A is CORRECT. (Return the form, even if the information is correct.)

 Section A is INCORRECT. (Update Section B and return the form.)

Contact Information					New Contact and/or Updated Information (Please Print)
Title					Title – Mark (X) one ___ Mr. ___ Mrs. ___Miss ___ Ms. ___ Dr. ___ The Honorable
First Name				MI	First Name				MI
Last Name					Last Name
Name Suffix					Name Suffix – (Jr., Sr., II, III, etc.)
Department Name					Department Name – (e.g., Board of Commissioners, Planning and Development)
Position					Position – (e.g., Chairman, Supervisor, Mayor)
Term Expiration Date		Term			Term Expiration Date – (mm/dd/yyyy)	Term (e.g., 2 years,4 years)
Preferred Address					Preferred Address – (Number and street name or P.O. Box)
City			State		City			State
ZIP			ZIP+4		ZIP			ZIP+4
Alternate Address					Alternate Address – (Number and street name)
City			State		City			State
ZIP Code			ZIP+4		ZIP Code			ZIP+4
Phone			Ext		Phone			Ext
Alternate Phone	FAX				Alternate Phone (includes cell)		FAX
Email					Email

Name and Position of Person Completing This Form (Please print)

Name ________________________________________________________ Telephone Number ( )________________ Ext_________

Position________________________________________________________________________________________________________

Email Address _________________________________________________________________ Date _____________________________

Complete this form, return it using the enclosed postage-paid envelope, and address it to ATTN: Geography LUCA Materials 63-E, National Processing Center, 1201 East 10^th St, Jeffersonville, IN 47132. Rather than mailing, you may scan your completed form and email it to [email protected].