South Carolina Universal Service Fund Contribution Worksheet (Page 3 of 5) in pdf

South Carolina Universal Service Fund Contribution Worksheet Page 3

Attachment 2, Worksheet #1

South Carolina Universal Service Fund Contribution Worksheet

Certification of Revenues:

111 Revenues:

(a)Total Interstate End User Operating Revenues in South Carolina for 12 months

peroid ending 12/31/2001:______________________________________

(b)Total Intrastate End User Operating Revenues in South Carolina for 12 months

period ending 12/31/2001:_______________________________________

(c)Total Interstate and Intrastate End User Operating Revenues in South Carolina for

12 months period ending 12/31/2001:_________________________________________

112 Certification of Report: I certify that I am an officer of the above named reporting

entity, that I have examined the foregoing report and to the best of my knowledge,

information, and belief, all of the statements in this Contribution Worksheet are true and

that said Worksheet is an accurate statement of affairs of the above named Company for

the time period covered in this report.

Signature:______________________________ Date:___________________

Printed name of Officer signing above :____________________________

Position of Officer signing above :________________________________

SWORN TO AND SUBSCRIBED BEFORE ME

this the ________ day of ________________, 20____

__________________________________________

NOTARY PUBLIC

My Commission Expires:_______________________

South Carolina Universal Service Fund Contribution Worksheet Page 3