Looking for a Irs Forms And Templates? Download it for free!

2009 FCC Form 499-A Telecommunications Reporting Worksheet (Reporting Calendar 2008 Revenues)

Page 8

Block 6: CERTIFICATION: to be signed by an officer of the filer

601 Filer 499 ID [from Line 101]

602 Legal name of reporting entity [from Line 102]

Section IV of the instructions provides information on which types of reporting entities are required to file for which purposes. Any entity claiming

to be exempt from one or more contribution requirements should so certify below and attach an explanation. [The Universal Service Administrator

will determine which entities meet the de minimis threshold based on information provided in Block 4, even if you fail to so certify, below.]

603 I certify that the reporting entity is exempt from contributing to:

Universal Service

TRS

NANPA

LNP Administration

Provide explanation below:

604 Please indicate whether the reporting entity is

State or Local Government Entity

I.R.C. § 501 or State Tax Exempt (see instructions)

605 I certify that the revenue data contained herein are privileged and confidential and that public disclosure of such information would likely cause substantial harm to the competitive

position of the company. I request nondisclosure of the revenue information contained herein pursuant to Sections 0.459, 52.17, 54.711 and 64.604 of the Commission's Rules.

I certify that I am an officer of the above-named reporting entity as defined on page 33 of the instructions, that I have examined the foregoing report and,

to the best of my knowledge, information and belief, all statements of fact contained in this Worksheet are true and that said Worksheet is an accurate

statement of the affairs of the above-named company for the previous calendar year. In addition, I swear, under penalty of perjury, that all

requested identification registration information has been provided and is accurate. If the above-named reporting entity is filing on a

consolidated basis, I certify that this filing incorporates all of the revenues for the consolidated entities for the entire year and that

the filer adhered to and continues to meet the conditions set forth in Section II-B of the instructions.

606 Signature

First

Last

607 Printed name of officer

608 Position with reporting entity

609 Business telephone number of officer

(

) -

ext -

610 Email of officer

|| Required if available -- not for public release ||

611 Date

Original April 1 filing for year

New filer, registration only

Revised filing with updated registration

Revised filing with updated revenue data

612 Check those that apply:

Do not mail checks with this form. Send this form to: Form 499 Data Collection Agent c/o USAC 2000 L Street, N.W. Suite 200 Washington DC, 20036

For additional information regarding this worksheet contact: Telecommunications Reporting Worksheet information: (888) 641-8722 or via email:

PERSONS MAKING WILLFUL FALSE STATEMENTS IN THE WORKSHEET CAN BE PUNISHED BY FINE OR IMPRISONMENT UNDER TITLE 18 OF THE UNITED STATES CODE, 18 U.S.C. § 1001

Save time, avoid problems -- file electronically at

FCC Form 499-A

February 2009