Form FCC Form 324 FCC Form 324 Operator, Mail Address, and Operational Information Chan

FEDERAL COMMUNICATIONS COMMISSION WASHINGTON, DC 20554 OPERATOR, MAIL ADDRESS, AND OPERATIONAL INFORMATION CHANGES FCC Form 324

1. Indicate the nature of the operational change

Ownership Change	Legal Name Change	Assumed / dba Name Change
Mailing Address Change	Operational Status Change	Physical System ID Change

2. Indicate legal name, dba name, mailing address, and telephone number of the cable system operator.

Legal Name      		FCC Registration No. (FRN)     -  -    
Assumed/ doing business as name (dba)      
Mailing Address      	City      		State   	Zip Code      
Telephone No. (     )    -      	Email (optional)      @     .   

3. Indicate whether the operator is an individual, private association, partnership, corporation, or Government entity.

Individual

Private Association

Partnership

Corporation

Government Entity

4. Indicate the Physical System Identifier (PSID) if the community will be served by a different system:      

5. Describe the change to CUID (e.g. operation terminated, community merged, merging PSIDs, etc.)

     

6. If the community is merged, provide the Community Unit Identifier (CUID) that it is being merged into:      

7. Indicate on Exhibit 1 the names and the Community Unit Identifiers (CUIDs) (e.g. , CA0001) affected.

8. Certification

By signing below, the operator also certifies that neither the operator nor any other “party” to the notification is subject to a denial of federal benefits that includes FCC benefits pursuant to Section 5301 of the Anti-Drug Abuse Act of 1988, 21 U.S.C. § 862. For the definition of a “party” for this purpose refer to 47 C.F.R. § 1.2002(b).

Type or Print Name      	Title      
Signature      	Date      

WILLFUL FALSE STATEMENTS ON THIS FORM ARE PUNISHABLE BY FINE AND/OR IMPRISONMENT (18 U.S.C. § 1001) AND/OR REVOCATION OF ANY STATION LICENSE (47 U.S.C. § 312 (a) (1)), AND/OR FORFEITURE (47 U.S.C. § 503(b)).

EXHIBIT 1

FCC Identifier	Community Name
     	     
     	     
     	     
     	     
     	     
     	     
     	     
     	     
     	     
     	     
     	     
     	     
     	     
     	     
     	     
     	     
     	     
     	     
     	     
     	     
     	     
     	     
     	     
     	     
     	     
     	     
     	     
     	     
     	     
     	     
     	     
     	     
     	     
     	     

Use Additional Pages As Needed

INSTRUCTIONS FOR FCC FORM 324

OPERATOR, MAIL ADDRESS, AND OPERATIONAL STATUS CHANGES

A cable operator is required to notify the Commission in writing within 30 days following a change to the operator, legal name, mail address, and operational status change (47 CFR § 76.1610). No fees are required for § 76.1610 changes.

1. Indicate the nature of the operational change by checking the appropriate box or boxes. Possible changes include: ownership change, legal name change, assumed/does business as (dba) name change, mailing address change, community operational status change, and/or physical system identification (PSID) change.

2. Provide the cable operator’s legal name, FCC Registration Number (FRN), any assumed name for doing business as (dba) in the community, complete mailing address including zip code, and telephone number in the spaces provided.

3. Indicate whether the operator is an individual, private association, partnership, corporation, or government entity by checking the appropriate box. If the operator is a partnership, the legal name of the partner responsible for communications with the Commission shall be supplied.

4. Indicate the Physical System Identifier if the community will be served by a different system.

5. If the Physical System Id (PSID) of the community(ies) is changing, indicate the new PSID that will serve the community in the space provided. If the community is being served from a new headend that does not yet have a PSID, a new PSID will be assigned to the community provided in Exhibit 1. A separate Form 324 is required for each new PSID assignment.

6. For an operational status change, describe the nature of the change in the box provided. In order to merge a community into another community, both the existing CUID and the CUID into which the community is being merged must be provided.

7. List all the Community Unit Identifiers (CUIDs) and the corresponding names of the communities affected by this form on Exhibit 1.

8. The person responsible for this form must provide their name, title, signature, and the date in the space provided.

Send completed Form 324 to:

Federal Communications Commission

Media Bureau

445 12^th Street, SW

Washington, DC 20554

FCC NOTICE REQUIRED BY THE PAPERWORK REDUCTION ACT

If you do not provide the information requested on this form, the application may be returned without action having been taken upon it or its processing may be delayed while a request is made to provide the missing information. Your response is required to obtain the requested authorization.

We have estimated that each response to this collection of information will take 30 minutes. Our estimate includes the time to read the instructions, look through existing records, gather and maintain the required data, and actually complete and review the form or response. If you have any comments on this burden estimate, or on how we can improve the collection and reduce the burden it causes you, please e-mail them to [email protected] or send them to the Federal Communications Commission, AMD-PERM, Paperwork Reduction Project (3060-1045), Washington, DC 20554. Please DO NOT SEND COMPLETED APPLICATIONS TO THIS ADDRESS. Remember - you are not required to respond to a collection of information sponsored by the Federal government, and the government may not conduct or sponsor this collection, unless it displays a currently valid OMB control number of if we fail to provide you with this notice. This collection has been assigned an OMB control number of 3060-1045.

THE FOREGOING NOTICE IS REQUIRED BY THE PAPERWORK REDUCTION ACT OF 1995, P.L. 104-13, OCTOBER 1, 1995, 44 U.S.C. 3507.

Federal Communications Commission Approved by OMB

Washington, D.C. 20554 3060-1045

December 2003