FCC 394 |
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APPLICATION FOR FRANCHISE AUTHORITY |
CONSENT TO ASSIGNMENT OR TRANSFER OF CONTROL |
OF CABLE TELEVISION FRANCHISE |
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FOR FRANCHISE AUTHORITY USE ONLY |
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SECTION I. GENERAL INFORMATION |
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DATE |
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1. Community Unit Identification Number: |
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2. Application for: |
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Assignment of Franchise |
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Transfer of Control |
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3. Franchising Authority: |
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4. Identify community where the system/franchise that is the subject of the assignment or transfer of control is located: |
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5. Date system was acquired or (for system's constructed by the transferor/assignor) the date on |
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which service was provided to the first subscriber in the franchise area: |
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6. Proposed effective date of closing of the transaction assigning or transferring ownership of the |
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system to transferee/assignee: |
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7. Attach as an Exhibit a schedule of any and all additional information or material filed with this |
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Exhibit No. |
application that is identified in the franchise as required to be provided to the franchising |
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authority when requesting its approval of the type of transaction that is the subject of this |
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application. |
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PART I - TRANSFEROR/ASSIGNOR |
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1. Indicate the name, mailing address, and telephone number of the transferor/assignor. |
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Legal name of Transferor/Assignor (if individual, list last name first) |
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Assumed name used for doing business (if any) |
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Mailing street address or P.O. Box |
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City |
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ZIP Code |
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Telephone No. (include area code) |
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2.(a) Attach as an Exhibit a copy of the contract or agreement that provides for the assignment or |
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Exhibit No. |
transfer of control (including any exhibits or schedules thereto necessary in order to understand the |
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terms thereof). If there is only an oral agreement, reduce the terms to writing and attach. |
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(Confidential trade, business, pricing or marketing information, or other information not otherwise |
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publicly available, may be redacted). |
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(b) Does the contract submitted in response to (a) above embody the full and complete agreement |
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Yes |
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No |
between the transferor/assignor and the transferee/assignee? |
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If No, explain in an Exhibit. |
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Exhibit No. |
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PART II - TRANSFEREE/ASSIGNEE |
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1.(a) Indicate the name, mailing address, and telephone number of the transferee/assignee. |
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Legal name of Transferee/Assignee (if individual, list last name first) |
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Assumed name used for doing business (if any) |
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Mailing street address or P.O. Box |
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City |
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State |
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ZIP Code |
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Telephone No. (include area code) |
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(b) Indicate the name, mailing address, and telephone number of person to contact, if other than transferee/assignee. |
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Name of contact person (list last name first) |
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Firm or company name (if any) |
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Mailing street address or P.O. Box |
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City |
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Telephone No. (include area code) |
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(c) Attach as an Exhibit the name, mailing address, and telephone number of each additional person who |
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Exhibit No. |
should be contacted, if any. |
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(d) Indicate the address where the system's records will be maintained. |
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Street address |
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City |
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State |
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ZIP Code |
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2. Indicate on an attached exhibit any plans to change the current terms and conditions of service and |
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Exhibit No. |
operations of the system as a consequence of the transaction for which approval is sought. |
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SECTION II. TRANSFEREE'S/ASSIGNEE'S LEGAL QUALIFICATIONS |
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1. |
Transferee/Assignee is: |
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Corporation |
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a. Jurisdiction of incorporation: |
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d. Name and address of registered agent in |
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jurisdiction: |
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b. Date of incorporation: |
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c. For profit or not-for-profit: |
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Limited Partnership |
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a. Jurisdiction in which formed: |
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c. Name and address of registered agent in |
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jurisdiction: |
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b. Date of formation: |
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General Partnership |
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a. Jurisdiction whose laws govern formation: |
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b. Date of formation: |
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Individual |
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Other. Describe in an Exhibit. |
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Exhibit No. |
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2. |
List the transferee/assignee, and, if the transferee/assignee is not a natural person, each of its officers, directors, stockholders |
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beneficially holding more than 5% of the outstanding voting shares, general partners, and limited partners holding an equity |
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interest of more than 5%. Use only one column for each individual or entity. Attach additional pages if necessary. (Read |
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carefully - the lettered items below refer to corresponding lines in the following table.) |
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(a) |
Name, residence, occupation or principal business, and principal place of business. (If other than an individual, also show |
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name, address and citizenship of natural person authorized to vote the voting securities of the applicant that it holds.) List the |
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applicant first, officers, next, then directors and, thereafter, remaining stockholders and/or partners. |
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(b) |
Citizenship. |
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(c) |
Relationship to the transferee/assignee (e.g., officer, director, etc.). |
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(d) |
Number of shares or nature of partnersihp interest. |
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(e) |
Number of votes. |
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(f ) |
Percentage of votes. |
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(a) |
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(b) |
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(c) |
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(d) |
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(e) |
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(f ) |
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3. |
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If the applicant is a corporation or a limited partnership, is the transferee/assignee formed under the |
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Yes |
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No |
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laws of, or duly qualified to transact business in, the State or other jurisdiction in which the system |
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operates? |
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If the answer is No, explain in an Exhibit. |
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Exhibit No. |
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4. |
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Has the transferee/assignee had any interest in or in connection with an applicant which has been |
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Yes |
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No |
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dismissed or denied by any franchise authority? |
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If the answer is Yes, describe circumstances in an Exhibit. |
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Exhibit No. |
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5. |
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Has an adverse finding been made or an adverse final action been taken by any court or |
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Yes |
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No |
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administrative body with respect to the transferee/assignee in a civil, criminal or administrative |
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proceeding, brought under the provisions of any law or regulation related to the following: any |
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felony; revocation, suspension or involuntary transfer of any authorization (including cable |
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franchises) to provide video programming services; mass media related antitrust or unfair |
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competition; fraudulent statements to another government unit; or employment discrimination? |
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If the answer is Yes, attach as an Exhibit a full description of the persons and matter(s) involved, |
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Exhibit No. |
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including an identification of any court or administrative body and any proceeding (by dates and file |
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numbers, if applicable), and the disposition of such proceeding. |
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6. |
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Are there any documents, instruments, contracts or understandings relating to ownership or future |
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Yes |
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No |
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ownership rights with respect to any attributable interest as described in Question 2 (including, but |
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not limited to, non-voting stock interests, beneficial stock ownership interests, options, warrants, |
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debentures)? |
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If Yes, provide particulars in an Exhibit. |
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7. |
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Do documents, instruments, agreements or understandings for the pledge of stock of the |
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Yes |
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No |
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transferee/assignee, as security for loans or contractual performance, provide that: (a) voting rights |
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will remain with the applicant, even in the event of default on the obligation; (b) in the event of |
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default, there will be either a private or public sale of the stock; and (c) prior to the exercise of any |
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ownership rights by a purchaser at a sale described in (b), any prior consent of the FCC and/or of the |
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franchising authority, if required pursuant to federal, state or local law or pursuant to the terms of |
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the franchise agreement will be obtained? |
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If No, attach as an Exhibit a full explanation. |
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Exhibit No. |
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SECTION III. TRANSFEREE'S/ASSIGNEE'S FINANCIAL QUALIFICATIONS |
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1. |
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The transferee/assignee certifies that it has sufficient net liquid assets on hand or available from |
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Yes |
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No |
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committed resources to consummate the transaction and operate the facilities for three months. |
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2. |
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Attach as an Exhibit the most recent financial statements, prepared in accordance with generally |
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Exhibit No. |
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accepted accounting principals, including a balance sheet and income statement for at least one full |
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year, for the transferee/assignee or parent entity that has been prepared in the ordinary course of |
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business, if any such financial statements are routinely prepared. Such statements, if not otherwise |
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publicly available, may be marked CONFIDENTIAL and will be maintained as confidential by the |
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franchise authority and its agents to the extent permissible under local law. |
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SECTION IV. TRANSFEREE'S/ASSIGNEE'S TECHNICAL QUALIFICATIONS |
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Set forth in an Exhibit a narrative account of the transferee's/assignee's technical qualifications, experience |
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Exhibit No. |
and expertise regarding cable television systems, including, but not limited to, summary information about |
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appropriate management personnel that will be involved in the system's management and operations. The |
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transferee/assignee may, but need not, list a representative sample of cable systems currently or formerly |
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owned or operated. |
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SECTION V - CERTIFICATIONS |
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Part I - Transferor/Assignor |
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All the statements made in the application and attached exhibits are considered material representations, and all the Exhibits |
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are a material part hereof and are incorporated herein as if set out in full in the application. |
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Signature |
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I CERTIFY that the statements in this application are true, |
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complete and correct to the best of my knowledge and belief and |
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are made in good faith. |
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Date |
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WILLFUL FALSE STATEMENTS MADE ON THIS FORM ARE |
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PUNISHABLE BY FINE AND/OR IMPRISONMENT. U.S. CODE, |
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Print full name |
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TITLE 18, SECTION 1001. |
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Check appropriate classification: |
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Individual |
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General Partner |
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Corporate Officer (Indicate Title) |
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Other. Explain: |
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Part II - Transferee/Assignee |
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All the statements made in the application and attached Exhibits are considered material representations, and all the Exhibits |
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are a material part hereof and are incorporated herein as if set out in full in the application. |
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The transferee/assignee certifies that he/she: |
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(a) Has a current copy of the FCC's Rules governing cable television systems. |
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(b) Has a current copy of the franchise that is the subject of this application, and of any applicable state laws or local |
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ordinances and related regulations. |
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(c) Will use its best efforts to comply with the terms of the franchise and applicable state laws or local ordinances and related |
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regulations, and to effect changes, as promptly as practicable, in the operation system, if any changes are necessary to cure |
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any violations thereof or defaults thereunder presently in effect or ongoing. |
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Signature |
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I CERTIFY that the statements in this application are true, |
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complete and correct to the best of my knowledge and belief and |
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are made in good faith. |
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Date |
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WILLFUL FALSE STATEMENTS MADE ON THIS FORM ARE |
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PUNISHABLE BY FINE AND/OR IMPRISONMENT. U.S. CODE, |
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Print full name |
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TITLE 18, SECTION 1001. |
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Check appropriate classification: |
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Individual |
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General Partner |
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Corporate Officer (Indicate Title) |
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Other. Explain: |
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