Federal Communications Commission Washington, D.C. 20554
Approved by 0MB 3060-0700
FCC FORM 1275 CERTIFICATION FOR OPEN VIDEO SYSTEMS
Company
Name:
Contact
Person:
Mailing
Address:
City:
IState:
IFax Number:
IZip Code ,
Phone Number:
Yes 1. If you are a cable operator applying for certification within your cable franchise area, are you qualified to operate an open video system under 47 C.F.R. § 76.1501 ? ? Do you agree to comply and to remain in compliance with each of the Commission's regulations in 47 C.F .R. §§ 76.1503, 76.1504, 76.1506(m), 76.1508, 76.1509, and 76.1513? 3. Do you agree to comply with the Commission's notice and enrollment requirements Tor unaffiliated video programming providers? 4. If applicable, do you agree to file changes to your cost allocation 60 days before the commencement of service? manual at least
No
N/A
, .t:>rovide a general description of the anticipated communities or areas to be served upon completion of the system. .!c
f
2. Anticipated 4. If Switched
Number
Digital Capacity. Digital, Anticipated
Input -Ports:
Anticipated
of Channel
WILLFUL
FALSE STATEMENTS
MADE ON THIS FORM ARE PUNISHABLE 1001), AND/OR FORFEITURE
BY FINE AND/OR according
IMPRISONMENT 503) avail; to the most recent information
(U.S. CODE TITLE 18, SECTION To the best of my knowledge Name: --I
(U.S. CODE, TITLE 47, SECTION
and belief, the representations
made herein are accurate Signature: Date:
FCC Form August
1275 1996
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