Statement Of Termination Of Existing Franchise Form - State Of South Carolina - Secretary Of State

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STATE OF SOUTH CAROLINA
SECRETARY OF STATE
STATEMENT OF TERMINATION OF EXISTING FRANCHISE
PREVIOUSLY ISSUED BY MUNICIPALITY OR COUNTY
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).
TYPE OR PRINT CLEARLY WITH BLACK INK
Pursuant to Section 58-12-325 of the 1976 South Carolina Code of Laws, as amended, the
following cable or video service provider hereby exercises its option to terminate existing franchises
issued by the municipalities and/or counties listed below and instead offer cable or video service in such
municipalities or counties under a certificate of authority that the Secretary of State shall issue in
accordance with the requirements of Section 58-12-310. Termination of existing franchises is effective
immediately upon issuance of a Certificate of Franchise Authority by the Secretary of State granting
authority to provide cable service in the described municipalities and counties.
1.
Name of the provider:
2.
Municipalities or counties where existing franchises are proposed to be terminated upon issuance
of a State-issued Certificate of Franchise Authority in accordance with Section 58-12-301:
3.
Copies of this filing shall be submitted to any affected municipalities and/or counties.
Date
Name of Cable Service Provider
Signature
Type or Print Name and Office
Address
Telephone Number
Form Revised by South Carolina
STATEMENT OF TERMINATION OF EXISTING FRANCHISE ISS.UED BY MUNICIPALITY/ COUNTY
Secretary of State June 2008

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