P4-04 2022 SLD Verification Form (DC)

OMB Number: 0607-0988
Expiration Date: XX-XX-2024

PHASE 4 (POST 2020 CENSUS) CITY WARD BOUNDARY VERIFICATION FORM FOR THE DISTRICT OF COLUMBIA

I have reviewed the city ward boundaries, identifying numbers (and names if applicable). I certify that the boundaries, numbers, and names are correct as shown.

City Ward – (SLDU)

I have reviewed the city ward boundaries, identifying numbers (and names if applicable). I certify that the boundaries are correct as shown, except for the following block assignments specified below:

City Ward – (SLDU)

I have reviewed the city ward boundaries, identifying numbers (and names if applicable). I verify that the boundaries are correct as shown, except for the identified block assignments. In lieu of specifying the incorrect block assignments, codes, or names, we are providing corrections by sending a new block equivalency file via e-mail to [email protected].

City Ward – (SLDU)

Date ___________ Signature ____________________________________

Name ___________________________________________________________

Title ___________________________________________________________

Address ___________________________________________________________

City _______________________ State ___________ Zip Code __________

E-mail ___________________________________________________________

Fax ___________________________________________________________

County (code)	Census Tract	Census Block	Incorrect District #	Correct District #

Please return this form by e-mail to [email protected] or by FAX at 301-763-4348.