Eoem.L Tomer Tf4n\L. Bosc.Ar:\\O
To be filed in DMM Matter Number: 09-01904 State of New York Department of Public Service Three Empire State Plaza, Albany, New York 12223-1350 Internet Address: http://www.dps.ny.gov APPLICATION FOR SMALL COMPANY EXEMPTION I HEREBY DECLARE THAT TO THE BEST OF MY KNOWLEDGE, THIS STATEMENT IS ACCURATE. I UNDERSTAND THIS INFORMATION MAY BE SUBJECT TO VERIFICATION BY THE COMMISSION: Name of Company .b ta" 3s2. .210 mo.," S+-. G,erm41\.to~n Y\J J)..s2.1., Address HAD UNDER 1,000 SUBSCRIBERS AS OF DECEMBER 31, 2011. Signature Geoem.l ToMer Title . ( Sl8) 5?>7- '-l'l3S- fr Telephone (include area code) Tf4n\l. bosc.a.r:\\o @~dcorp.~ Email Address Instructions: This Application, and a copy of your most recent rate card, must be completed and returned each year, on or before April 1st, to claim small company exempt status for the previous year, pursuant to Section 213.2 of the Public Service Law. Mail completed Application to the attention of the Carrier Operations Section, Office of Telecommunications, New York State Department of Public Service, Three Empire State Plaza, Albany, New York 12223. If you have any questions or require assistance in this matter, please call (518) 474-4500. 1 List below the name of each municipality granting a franchise and each area you serve in which a franchise has not been granted. In addition, provide information for each municipality and area served as indicated on table below. Indicate operation in a non franchised area by placing the letter "N" after the area served.
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