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i <br /> FORM 0-128 U.S.DEPARTMENT OF CCMMERCE <br /> 9-9-98) BUREAU OF n+E CENSUS <br /> CONFIDENTIALITY AGREEMENT 6 <br /> ADDRESS LIST REVIEW 1999 <br /> Local Update of Census Addresses (LUCA) Program <br /> United States Census 2000 <br /> 1. Name of your organization <br /> C037135 - orange county <br /> 2. Address (Number and Street,RR,HC or Post Cfte Box Number) <br /> P0. 6x 7.10D S_ C14,0"611t 10A, J-7-- <br /> 3. City State ZIP Code <br /> Cz s f.3 o rho uG-hr Ill C '"7 Z`7 <br /> 4. Governmental Units Represented by your organization <br /> C: A Aj C <br /> S. Marne of your Primary LUCA Adress List Review Liaison <br /> go 3 c.a 4E PC—EvE <br /> 6.Responsibilities of liaisons participating In Address list 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 fine of not more than$5,000,or imprisonment for <br /> not more than flue years,or both. <br /> M2 <br /> . .:.......... _ <br /> y"" <br /> :m. <br /> .a n <br /> Or C v -- <br /> (Primary Address List Review Uaison) <br /> A JAS 740 P D44 4P V. Z.r4 7 <br /> f*44.4 IL <br /> TA:co <br /> I r t �C1- 9A jJ r�-r- a3 <br /> �r AJ I*►T 6 ; Q <br /> You may duplicate this form it you require more signature blocks. <br />