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413� <br /> OMB No. 0607-0795 <br /> FORM D-1669 U.S. DEPARTMENT OF COMMERCE ENTITY ID <br /> (6-12-2007) _ Economics and S[atistics Administralion <br /> U.S.CENSUS BUREAU <br /> C�NFIDENTIALITY AGREEMENT <br /> LOCAL UPDATE OF CENSUS ADDRESSES (LUCAj PROGRAM <br /> 2010 Decennial Census PL1718823 <br /> PLEASE PR/NT <br /> 1. Government name <br /> ��t a f D��fi�� <br /> 2. Name of UCA Liaison's Office or Department (Assessor's Office, P/anning Department, etc.) <br /> �..C�rOrnrl i� a� C�`s' bot� �R�P C�� �1 �! `m-Q.v�+ <br /> 3. Address (Nouse number and street name, RR, HC, or PO box number) <br /> I C�n-� I� -A�-,c�,e�..� � � <br /> 4. City, State, ZIP Code <br /> ��Cq�-il�-� I Ll. 1 NO 1 S � �`,Z.�`�..�, <br /> Responsibilities for Participating in the 2010 Decenniai Census WCA Program <br /> AIi 201� Decennial Census LUCA Program liaisons, reviewers, and anyone with access to Title 13 materials must agree <br /> #a keep confidential the U.S. Census Bureau address information (including map structure points provided for feedback) <br /> they review or to which they have access, They may use this information solely for suggesting improvemer�ts to the <br /> Census Bureau's address list and maps. All individuals who will be reviewing Census Bureau addresses or have access <br /> #o Title 13 materiais must sign below to indicate they have read and understand the Census Bureau's results regarding <br /> restricfions related to confiden#ial information. By signing this agreement, your government agrees to return or destroy all <br /> Title 13, Census Bureau confidentiai materials to the Gensus Bureau afiter tl�e LUCA Program appeals process is <br /> complete. in addition, those who sign the agreement indicate that they understand the penalty for disclosing information <br /> about addresses or individuals obtained by the Census Bureau, including maps that contain structure points showing the <br /> location of housing units or group quarters is a fine of not more than $250,000 or imprisonment for no3 more than 5 <br /> years, or bo#h. Although access to the data is temporary,this commitment is permanent. You must be at least 18 years <br /> of age to sign tn'rs agreemen#. <br /> . <br /> . <br /> . . ... <br /> Printed name Rrea code Telephone number City <br /> V�+S�b�l� �tNNAmA�P►3�I �, t - 4 � y - �, ��- z3 �� , <br /> Signature Date State ZtP Code <br /> � Mon#h Day Year � <br /> ���' O 8 2 °� `vb O '� <br /> - s <br /> - � - • .�• <br /> Printed name Area cade Telephone number City <br /> �u zc� F�t-�c��� d I `7 -�- ,2 CP <br /> Signature Date State ZIP Code <br /> / Month Day Year � <br /> J 0 / 7 2 c7 c� <br /> Printe name Area code Telephone number City <br /> �ra �J oe s o� eI' 2 ' '� " �l s O — 2 L 1 $ <br /> Signature Date State ZIP Code <br /> �� Month Day Year � <br /> / O d 3 2 v o � I <br /> Printed name Area code Telephone number City <br /> �� —� — � <br /> Signature Date State ZIP Code <br /> Manth Day Year � <br /> I <br /> Printed name Area code Telephone number City <br /> � —� — � <br /> Signature pate State ZIP Code <br /> Month Day Year � <br /> I <br /> U S C E N S U S B U R E A U If you require more signature blocks, you may duplicate this form. <br />