Free STATE OF SOUTH CAROLINA - South Carolina


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STATE OF SOUTH CAROLINA SECRETARY OF STATE

NOTICE OF TRANSFER OF STATE-ISSUED CERTIFICATE OF FRANCHISE AUTHORITY
TYPE OR PRINT CLEARLY WITH BLACK INK

Pursuant to S.C. Code Section 58-12-310(F), the undersigned hereby provides notice of the transfer of the certificate of franchise authority. 1. The name of the entity holding the certificate of franchise authority is

2. 3.

Date certificate of franchise authority issued The name of the successor in interest to whom the certificate of franchise authority is being transferred

4.

The street address of the successor in interest is
Street Address

City

County

State

Zip Code

The mailing address of the successor in interest is

5.

This notice is accompanied by an affidavit signed by an officer or general partner of the successor in interest as required by S.C. Code Section 58-12-310(B) & (F).

Date
Officer/General Partner's Signature

Type or Print Name

Address

Telephone Number
NOTICE OF TRANSFER

Form Revised by South Carolina Secretary of State June 2008

AFFIDAVIT REGARDING TRANSFER OF STATE-ISSUED CERTIFICATE OF FRANCHISE AUTHORITY

PERSONALLY appeared before me the undersigned who being duly sworn according to law,
deposes and says on oath: My name is of and my title/position is .This

affidavit is based upon my personal knowledge of the facts contained in this affidavit. My company is the successor in interest to who holds a Certificate of Franchise

Authority. I certify and affirm that all such facts are true and correct. I affirm that my company agrees to comply with all applicable federal and state laws and regulations. My company is successor in interest to who currently

holds a Certificate of Franchise Authority to provide cable or video services in the following areas:

(Written description of the municipalities and unincorporated areas of the counties to be served in whole or in part. A map or other graphic representation may supplement, but not substitute for, the written description.)

The principal place of business for my company is located at

The principal executive officers of the applicant are:
Name & Title Address Telephone No.

Dated this

day of

,

.

SWORN to and subscribed before me this day of ,
Officer/General Partner's Signature

Type or Print Name

Notary Public for My Commission Expires:

Address

Telephone Number

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 and the affected municipalities or counties within ten (10) days of the completion of the transfer. If the space in this form is insufficient, please attach additional sheets containing a reference to the appropriate paragraph in this form. Return to: Secretary of State Attn: Wendy B. Holcombe Post Office Box 11350 Columbia, SC 29211

2.

3.

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). PURSUANT TO S.C. CODE OF LAWS 58-12-310(F), THE CERTIFICATE OF FRANCHISE AUTHORITY ISSUED BY THE SECRETARY OF STATE IS FULLY TRANSFERABLE TO A SUCCESSOR IN INTEREST TO THE APPLICANT TO WHICH IT IS INITIALLY GRANTED, PROVIDED THAT THE SUCCESSOR IN INTEREST FILES WITH THE SECRETARY OF STATE AN AFFIDAVIT THAT COMPLIES WITH THE REQUIREMENTS OF 58-12-310(B). A NOTICE OF TRANSFER MUST BE FILED WITH THE SECRETARY OF STATE AND THE AFFECTED MUNICIPALITIES OR COUNTIES WITHIN TEN DAYS OF THE COMPLETION OF THE TRANSFER.