**2008 Census Dress Rehearsal**

**Local Update of Census Addresses (LUCA) Program**

**Annexations and Detachments Form**

Please print or type the information about your government in the boxes
below.

**Government Name
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_**

**Entity Code
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_**

**[PERSON COMPLETING THIS FORM]{.mark}**

**Signature
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_**

**Your Name (Printed)
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_**

**Title
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_**

**[Telephone]{.mark}
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_**

**[FAX]{.mark}
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_[E-Mail
Address]{.mark}
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_**

Record below the information requested for all annexations (A) or
detachments (D) that you have added to the 2008 Dress Rehearsal LUCA
program map(s). Be sure that you put the authorization number and
effective date in or near the area on the map. The Census Bureau will
supply this information to the state certifying agency for your state;
please ensure that you properly file all legal changes with your state
government in accordance with your state's laws.

+-----+------------+---------+----------+-----------+----------------+
| **T | **Autho    | **Ef    | **County | **Minor   | **Estimated    |
| ype | rization** | fective | or       | Civil     | Area**         |
| o   |            | date**  | parish** | Division  |                |
| f** | ***Enter   |         |          | (if any)  | **Square miles |
|     | in column  | ***Mon  | **in     | in        | o r Acres (in  |
| *   | 2 -***     | th/day/ | which**  | which**   | hundredths)    |
| *Ch |            | year*** |          |           | (in tenths)**  |
| ang | O **--     |         | A        | A         |                |
| e** | O          | **(4)** | **(annex | **(anne   | **(7) (8)**    |
|     | rdinance** |         | ation)** | xation)** |                |
| A   |            |         |          |           |                |
| **o | R **--     |         | D        | D         |                |
| r** | Re         |         | **(detac | **(deta   |                |
| D   | solution** |         | hment)** | chment)** |                |
|     |            |         |          |           |                |
| *   | L **--     |         | **or**   | **or**    |                |
| *(1 | Local      |         |          |           |                |
| )** | Law**      |         | O        | O         |                |
|     |            |         | *        | **(other) |                |
|     | S **--     |         | *(other) | o         |                |
|     | S          |         | oc       | ccurred** |                |
|     | tate-level |         | curred** |           |                |
|     | action**   |         |          | **(6)**   |                |
|     |            |         | **(5)**  |           |                |
|     | X **--     |         |          |           |                |
|     | Other      |         |          |           |                |
|     | type**     |         |          |           |                |
|     |            |         |          |           |                |
|     | **Type     |         |          |           |                |
|     | Number**   |         |          |           |                |
|     |            |         |          |           |                |
|     | **(2)      |         |          |           |                |
|     | (3)**      |         |          |           |                |
+-----+------------+---------+----------+-----------+----------------+
|     |            |         |          |           |                |
+-----+------------+---------+----------+-----------+----------------+
|     |            |         |          |           |                |
+-----+------------+---------+----------+-----------+----------------+
|     |            |         |          |           |                |
+-----+------------+---------+----------+-----------+----------------+
|     |            |         |          |           |                |
+-----+------------+---------+----------+-----------+----------------+
|     |            |         |          |           |                |
+-----+------------+---------+----------+-----------+----------------+
|     |            |         |          |           |                |
+-----+------------+---------+----------+-----------+----------------+
|     |            |         |          |           |                |
+-----+------------+---------+----------+-----------+----------------+

D-1642