Licensing Division for the Correct Form
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This form is effective beginning with the January 1 to June 30, 2017 accounting period (2017/1) SA3E If you are filing for a prior accounting period, contact the Licensing Division for the correct form. Long Form Return completed workbook by STATEMENT OF ACCOUNT FOR COPYRIGHT OFFICE USE ONLY email to: for Secondary Transmissions by DATE RECEIVED AMOUNT Cable Systems (Long Form) [email protected] $ General instructions are located in 02/27/20 ALLOCATION NUMBER For additional information, the first tab of this workbook. contact the U.S. Copyright Office Licensing Division at: Tel: (202) 707-8150 A ACCOUNTING PERIOD COVERED BY THIS STATEMENT: Accounting 2019/2 Period Instructions: B Give the full legal name of the owner of the cable system. If the owner is a subsidiary of another corporation, give the full corpo Owner rate title of the subsidiary, not that of the parent corporation List any other name or names under which the owner conducts the business of the cable system If there were different owners during the accounting period, only the owner on the last day of the accounting period should submit a single statement of account and royalty fee payment covering the entire accounting period Check here if this is the system’s first filing. If not, enter the system’s ID number assigned by the Licensing Division. 063020 LEGAL NAME OF OWNER/MAILING ADDRESS OF CABLE SYSTEM Bellsouth Telecommunications, LLC 06302020192 063020 2019/2 2260 E Imperial Hwy Room 839 El Segundo, CA 90245 INSTRUCTIONS: In line 1, give any business or trade names used to identify the business and operation of the system unless these C names already appear in space B. In line 2, give the mailing address of the system, if different from the address given in space B. System IDENTIFICATION OF CABLE SYSTEM: 1 MAILING ADDRESS OF CABLE SYSTEM: 2 (Number, street, rural route, apartment, or suite number) (City, town, state, zip code) D Instructions: For complete space D instructions, see page 1b. Identify only the frst community served below and relist on page 1b Area with all communities. Served CITY OR TOWN STATE First BIRMINGHAM AL Community Below is a sample for reporting communities if you report multiple channel line-ups in Space G. CITY OR TOWN (SAMPLE) STATE CH LINE UP SUB GRP# Alda MD A 1 Sample Alliance MD B 2 Gering MD B3 Privacy Act Notice: Section 111 of title 17 of the United States Code authorizes the Copyright Offce to collect the personally identifying information (PII) requested on th form in order to process your statement of account. PII is any personal information that can be used to identify or trace an individual, such as name, address and telephone numbers. By providing PII, you are agreeing to the routine use of it to establish and maintain a public record, which includes appearing in the Offce's public indexes and in search reports prepared for the public. The effect of not providing the PII requested is that it may delay processing of your statement of account and its placement in the completed record of statements of account, and it may affect the legal suffciency of the fling, a determination that would be made by a court of law. U.S. Copyright Office Form SA3E Long Form (Rev. 05‐17) ACCOUNTING PERIOD: 2019/2 FORM SA3E. PAGE 1b. LEGAL NAME OF OWNER OF CABLE SYSTEM: SYSTEM ID# Bellsouth Telecommunications, LLC 063020 Instructions: List each separate community served by the cable system. A “community” is the same as a “community unit” as defined in FCC rules: “a separate and distinct community or municipal entity (including unincorporated communities within unincorporated D areas and including single, discrete unincorporated areas.” 47 C.F.R. §76.5(dd). The frst community that you list will serve as a form Area of system identifcation hereafter known as the “first community.” Please use it as the first community on all future filings. Served Note: Entities and properties such as hotels, apartments, condominiums, or mobile home parks should be reported in parentheses below the identified city or town. If all communities receive the same complement of television broadcast stations (i.e., one channel line-up for all), then either associate all communities with the channel line-up “A” in the appropriate column below or leave the column blank. If you report any stations on a partially distant or partially permitted basis in the DSE Schedule, associate each relevant community with a subscriber group, designated by a number (based on your reporting from Part 9). When reporting the carriage of television broadcast stations on a community-by-community basis, associate each community with a channel line-up designated by an alpha-letter(s) (based on your Space G reporting) and a subscriber group designated by a number (based on your reporting from Part 9 of the DSE Schedule) in the appropriate columns below. CITY OR TOWN STATE CH LINE UP SUB GRP# BIRMINGHAM AL AA 1 First Adamsville AL AA 1 Community Addison AL AA 1 Alabaster AL AA 1 Albertville AL AB 3 Alexander City AL AC 6 Alexandria AL AA 5 Anniston AL AA 2 See instructions for Arley AL AA 1 additional information Athens AL AB 3 on alphabetization. Attalla AL AA 1 Autauga Unincorporated County AL AC 6 Baileyton AL AA 1 Bessemer AL AA 1 Add rows as necessary. Bibb Unincorporated County AL AA 1 Blount Unincorporated County AL AA 1 Brighton AL AA 1 Brookwood AL AA 1 CALERA AL AA 1 Calhoun Unincorporated County AL AA 1 Center Point AL AA 1 Chelsea AL AA 1 Chilton Unincorporated County AL AA 1 Choccolocco AL AA 5 Clanton AL AA 1 Clay AL AA 1 Coaling AL AA 1 Coker AL AA 1 Colbert Unincorporated County AL AB 4 Columbiana AL AA 1 County Line AL AA 1 Cullman AL AA 1 Cullman Unincorporated County AL AA 1 Deatsville AL AC 6 Decatur AL AB 3 Dora AL AA 1 Douglas AL AB 3 Elmore Unincorporated County AL AC 6 Etowah Unincorporated County AL AA 1 Eva AL AB 3 Fairfield AL AA 1 Fairview AL AA 1 U.S. Copyright Office Form SA3E Long Form (Rev. 05‐17) Florence AL AB 4 Forestdale AL AA 1 Fultondale AL AA 1 Gadsden AL AA 1 Gardendale AL AA 1 Glencoe AL AA 2 Good Hope AL AA 1 Graysville AL AA 1 Guntersville AL AB 3 Harpersville AL AA 1 Hartselle AL AB 3 Harvest AL AB 3 Hayden AL AA 1 Hazel Green AL AB 3 Helena AL AA 1 Hokes Bluff AL AA 1 Holly Pond AL AA 1 Homewood AL AA 1 Hoover AL AA 1 Hueytown AL AA 1 Huntsville AL AB 3 Indian Springs AL AA 1 Irondale AL AA 1 Jacksonville AL AA 2 Jasper AL AA 1 Jefferson Unincorporated County AL AA 1 Jemison AL AA 1 Killen AL AB 3 Kimberly AL AA 1 Lake Purdy AL AA 1 Lake View AL AA 1 Lauderdale Unincorporated County AL AB 3 Lawrence Unincorporated County AL AB 3 Limestone Unincorporated County AL AB 3 Lipscomb AL AA 1 Locust Fork AL AA 1 Madison AL AB 3 Madison Unincorporated County AL AB 3 Marshall Unincorporated County AL AB 3 Maytown AL AA 1 Meadowbrook AL AA 1 Meridianville AL AB 3 Midfield AL AA 1 Mignon AL AA 1 Millbrook AL AC 6 Montevallo AL AA 1 Montgomery AL AC 6 Montgomery Unincorporated County AL AC 6 MORGAN UNINCORPORATED COUNTY AL AB 3 Morris AL AA 1 Moulton AL AB 3 Mount Olive AL AA 1 Mountain Brook AL AA 1 Mulga AL AA 1 Muscle Shoals AL AB 4 Northport AL AA 1 Oxford AL AA 2 Pelham AL AA 1 Pike Road AL AC 6 Pinson AL AA 1 U.S. Copyright Office Form SA3E Long Form (Rev. 05‐17) Pleasant Grove AL AA 1 Prattville AL AC 6 Priceville AL AB 3 Rainbow City AL AA 1 Saint Florian AL AB 4 Sheffield AL AB 4 Shelby AL AA 1 Shelby Unincorporated County AL AA 1 South Vinemont AL AA 1 Southside AL AA 1 Steele AL AA 1 Sumiton AL AA 1 Sylacauga AL AA 1 Sylvan Springs AL AA 1 Talladega Unincorporated County AL AA 1 Tarrant AL AA 1 Triana AL AB 3 Trinity AL AB 3 Trussville AL AA 1 Tuscaloosa AL AA 1 Tuscaloosa Unincorporated County AL AA 1 Tuscumbia AL AB 4 Underwood-Petersville AL AB 4 Vance AL AA 1 Vestavia Hills AL AA 1 Walker Unincorporated County AL AA 1 Warrior AL AA 1 Waterloo AL AB 4 Weaver AL AA 2 West Blocton AL AA 1 West End Cobb AL AA 1 West Point AL AA 1 Westover AL AA 1 Wetumpka AL AC 6 Wilsonville AL AA 1 Wilton AL AA 1 Winston Unincorporated County AL AA 1 Woodstock AL AA 1 Fayetteville TN AB 3 Lincoln Unincorporated County TN AB 3 U.S. Copyright Office Form SA3E Long Form (Rev. 05‐17) U.S. Copyright Office Form SA3E Long Form (Rev. 05‐17) ACCOUNTING PERIOD: 2019/2 FORM SA3E. PAGE 2. LEGAL NAME OF OWNER OF CABLE SYSTEM: SYSTEM ID# Name Bellsouth Telecommunications, LLC 063020 SECONDARY TRANSMISSION SERVICE: SUBSCRIBERS AND RATES E In General: The information in space E should cover all categories of secondary transmission service of the cable system, that is, the retransmission of television and radio broadcasts by your system to subscribers. Give information Secondary about other services (including pay cable) in space F, not here. All the facts you state must be those existing on the Transmission last day of the accounting period (June 30 or December 31, as the case may be).