New York Codes, Rules and Regulations
Title 9 - EXECUTIVE DEPARTMENT
Appendices
Appendix R-2

Universal Citation: 9 NY Comp Codes Rules and Regs ยง R-2

Current through Register Vol. 46, No. 12, March 20, 2024

APPLICATION FOR RENEWAL OF FRANCHISE

OR CERTIFICATE OF CONFIRMATION

1. The exact legal name of applicant is:

2. Applicant does business under the following trade name or names:

3. Applicant's mailing address is:

4. Applicant's telephone number(s) is (are):

5.

(a) This application is for a renewal of operating rights in the(city, town or village) of________.

(b) Applicant serves the following additional municipalities from the same headend or from a different headend but in the same or an adjacent county:

6. The number of subscribers in each of the municipalities noted above is:

Primary residential connections:

Secondary residential connections:

Residential pay-cable subscriptions:

Commercial connections:

Other:

7. The following signals are regularly carried by the applicant's cable system (where signals are received other than by direct off-air pickup, please so indicate):

8. Applicant does ________ does not ________ provide channel capacity and/or production facilites for local origination. If answer is affirmative, specify below the number of hours of locally originated programming carried by the system during the past twelve months and briefly describe the nature of the programming:

9. The current monthly rates for service in the municipality specified in Question 5(a) are:

Primary connections:

Secondary connections:

Pay-cable subscriptions:

Commercial connections:

Other:

10. How many miles of new cable television plant were placed in operation by applicant during the past twelve months in the municipality specified in Question 5(a)?

In the municipalities specified in Question 5(b)?

11. State and describe below any significant achievements and/or improvements that took place with respect to system operation during the past twelve months:

12. Indicate whether applicant has previously filed with the State

Commission on Cable Television its:

(a) Current Statement of Assessment pursuant to Section 817

of the Executive Law? Yes ________ No ________

(b) Current Annual Financial Report? Yes ________ No ________

If answer to any of above is negative, explain:

13. Has any event or change occurred during the past twelve months which has had, or could have, a significant impact upon applicant's ability to provide cable television service?

If so, describe below:

Signature

Title

________

Date

Please attach a copy of applicant's current annual performance test results per 9 NYCRR §596.5.

STATE OF NEW YORK )

) SS.:

COUNTY OF ALBANY )

VERIFICATION

[Name], being first duly sworn, deposes and says:

1. I am [Title] of [Name of Company] and I am familiar with the business operations of said company.

2. This application was prepared by me or under my direct supervision.

3. All of the statements and information contained herein are true and accurate to the best of my knowledge and belief.

[Signature]

Sworn to before me this day of________,

19________.

______________

[Notary Public]

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