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FORM D-128 U.S. DEPARTMENT OF COMMERCE <br />9•~-~8) BUREAU OF ?NE CENSUS <br />CONFIDENTIALITY AGREEMENT 6 <br />ADDRESS LIST REVIEW 1999 <br />Local Update of Census Addresses (LUCA) Program <br />United States Census 2000 <br />t. Name of your Organization <br />C037135 -Orange County <br />2. Addre38 (Number and Sbeet, RR, HC or Post Ofllce Box Number) <br />P, o. ~Qx S/~ / ~Z~ao s c,~rMe~.oN sr <br />3. City State ZIP Code <br />4. Governmental Units Represented by your Organization <br /> <br />5. Name of your Primary LUCA Adress List Review Liaison <br />~ ~E6v~E <br />s <br />R <br />~o <br />e <br />6. Responsibilities of liaisons participating in Address Ust Review activities <br />Address List Review Liaisons must agree to keep confidential the Census address information they review or <br />to which they have access. They may use this information solely for suggesting improvements to the Census <br />address list. All individuals from your organization who will be reviewing Census addresses need to sign below <br />to indicate they have read and understand the Census Bureau's rules on confidential information. <br />These rules are provided in the LUCA Technical Guide. <br />In addition, liaisons who sign below indicate they understand the penalty for disclosing information obtained <br />by the Census Bureau about addresses or individuals Is a Ane of not more than 55,000, or imprisonment for <br />not more than flue years, or both. <br />A~ c K .. ~SOR'$S~IOfE![Ar .,r <br />'+a. -si~ ' ~Rf@f~1~OtltA~ 'f` ~y ~jt,y~Tl~fgC <br />cb ~> ~ ~~ z~r.-' ~Q' <br />.. <br /> <br />///~/' <br />O ,r ~ o -~s z- /P/ <br />- O / <br /> <br />~///~~°14 (Primary Address Ust 1Rev~iew Liais~ofn) <br />/-'~r1ti W GCY <br />Q=JeT ZSOS <br />%/,~~9~' c y ~; s ra p _ a~•/ iiv E GL ~r ~ Sc ~ <br />i~-;: y'a - ~ ~,~- T,~;~-•~ S,M; ~XT Z o~ <br /> <br />~~ ~ ~ ~ b'~~ ~'Yi ~c/ G2 ~, 1~-,~r ZS'o3 <br /> <br /> <br /> <br /> <br /> <br />You may duplicate this form /1 you require more slgna~ture blocks. <br />