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STATE OF SOUTH CAROLINA SECRETARY OF STATE

NOTICE OF CHANGE OF PEG ACCESS CHANNELS
Pursuant to state law, a person or entity seeking to provide cable or video service must have a certificate of franchise authority, either an existing certificate issued by a local government under prior law, or upon expiration of that certificate issued by a local government, a state-issued certificate of franchise authority issued by the Secretary of State under S.C. Code of Laws §58-12-310(B).
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Pursuant to Section 58-12-370 of the 1976 South Carolina Code of Laws, as amended, the below-named municipality or county hereby provides notice to the Secretary of State of the following change to its cable or video service franchise Peg Access Channels. No such change shall be effective as to the holder of a State-issued Certificate of Franchise Authority earlier than one hundred twenty days (120) after the Secretary of State provides the holder written notice of change. 1. Municipality or County:

2.

Current cable or video service franchise activated Peg Access Channels:

3.

Proposed cable or video service franchise Peg Access Channels:

4.

Current holder(s) of State-Issued Certificates of Franchise Authority providing service in this municipality or county:
Provider Name and Title Address and Telephone No.

Date
Signature

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Type or Print Name and Title

_____________________
Address __________________________

______________ Telephone Number Form Revised by South Carolina Secretary of State June 2008

NOTICE OF CHANGE OF PEG ACCESS CHANNELS

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FILING INSTRUCTIONS
1. Two copies of this form, the original and either a duplicate original or conformed copy, must be filed with the Secretary of State. If the space in this form is insufficient, please attach additional sheets containing a reference to the appropriate paragraph in this form.

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Return to:

South Carolina Secretary of State Attn: Wendy B. Holcombe Post Office Box 11350 Columbia, SC 29211

SPECIAL NOTE PURSUANT TO STATE LAW, A PERSON OR ENTITY SEEKING TO PROVIDE CABLE OR VIDEO SERVICE MUST HAVE A CERTIFICATE OF FRANCHISE AUTHORITY, EITHER AN EXISTING CERTIFICATE ISSUED BY A LOCAL GOVERNMENT UNDER PRIOR LAW, OR UPON EXPIRATION OF THAT CERTIFICATE ISSUED BY A LOCAL GOVERNMENT, A STATE-ISSUED CERTIFICATE OF FRANCHISE AUTHORITY ISSUED BY THE SECRETARY OF STATE UNDER S.C. CODE OF LAWS §58-12-310(B).