<p> State of New York Department of Public Service Three Empire State Plaza, Albany, New York 12223-1350 Internet Address: http://www.dps.ny.gov</p><p>APPLICATION FOR SMALL COMPANY EXEMPTION</p><p>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:</p><p>______Name of Company ______Address</p><p>HAD UNDER 1,000 SUBSCRIBERS AS OF DECEMBER 31, 2011.</p><p>______Signature ______Title ______Telephone (include area code)</p><p>______Email Address</p><p>Instructions:</p><p>This Application, and a copy of your most recent rate card, must be completed and returned on or before April 1, 2012 to claim small company exempt status pursuant to Section 213.2 of the Public Service Law. Mail completed Application to the attention of Joseph Yakel, Utility Analyst 3, Network Reliability 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) 473-5244.</p><p>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. All fractional numbers should be rounded to the nearest tenth. Use a continuation page if addition space is required.</p><p>A. B. C. D. E. Franchise Area Number of Estimated % Total Miles Total Route Served Subscribers of Penetration of Plant Miles in Franchise Completed Area SAMPLE a. Anywhere, V. 100 50.0 10.0 12.5 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 </p><p>Total </p><p>______A. Identify whether a locality is a city, town, village or unincorporated area by using the following codes: ‘C’ – City, ‘T’ - Town, ‘V’ – Village B. Total amount of first or primary outlets not to include additional outlets or other services. C. % of penetration equals the number of subscribers in Column B divided by number of homes passed by cable. D. Total plant miles completed</p><p>2 E. Total miles of plant required to be constructed in municipality.</p><p>3</p>