Please answer every question in Section I.
- Today’s Date: The date you are filling out this form.
- Number of Certificates requested: If more than one copy is needed, indicate how many, and, on a separate
piece of paper, provide addressee name, title, office, and mailing
address for each additional certificate. There is a $35 fee for each
- a. Governmental Unit or Entity Name: The name of the governmental unit or entity name for which you are requesting certification.
- b. County or Counties: Provide the county or counties in which this governmental unit or entity is in.
- c. Name of highest elected official for this Governmental Unit or Entity.
- a. Contact Name: The name of the person filling out this form, i.e., requestor.
b.-i. self explanatory.
Note: No P.O. box addresses are accepted.
- a. Type of action
precipitating need for certification: Choose one.
b. Effective date of
action (mm/dd/yy): The effective date of the action checked in question 5a.
- a. Type of certification requested:
Annual: Certificate received after October 1 of calendar year.
Available only if boundaries included in the population certification
were effective as of January 1 of the current calendar year and reported by April. Please call 800-923-8282 for additional information.
Expedited: We will send your certificate within 3 months of
request. Provide the date the certificate is needed by. Please call 800-923-8282 for additional information.
b. If expedited, date certification needed (mm/dd/yy). Please allow 3 (three) months for processing from the time you place your request.
- Were the boundaries
included in the requested population certification reported in the
current or previous year’s Boundary and Annexation Survey?:
Please call 800-923-8282 for assistance in answering this question.
If you need further
assistance to complete Section I of this form, please contact the Census
Bureau’s Geographically Updated Population Certification Program staff on
301-763-2419, or the Customer Services Center staff on 1-800 923-8282 or 301-763-INFO (4636).
NOTE: Failure to meet deadlines may result in increased costs to customer.
Source: U.S. Census Bureau,
Customer Liaison and Marketing Services Office, Customer Services Center
Created: July 9, 2002
Friday, 01-Nov-2013 13:02:36 EDT