Form Boe-517-Tc - Property Statement - Telecommunications - 2013

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BOE-517-TC (S1F) REV. 15 (12-12)

STATE OF CALIFORNIA

PROPERTY STATEMENT—TELECOMMUNICATIONS

BOARD OF EQUALIZATION

2013

DECLARATION OF COSTS AND OTHER RELATED PROPERTY INFORMATION

AS OF 12:01 A.M., JANUARY 1, 2013

This statement must be completed, signed, and filed with the State-Assessed Properties Division, Board of Equalization,

P.O. Box 942879, Sacramento, California 94279-0061, by March 1, 2013. Omit cents; round to the nearest dollar.

OFFICIAL REQUEST

NAME, STREET, CITY, STATE and ZIP CODE

This request is made in accordance with section 826 of the Revenue

and Taxation Code. This property statement must be completed

according to the instructions and filed with the Board of Equalization

(BOE) on or before March 1, 2013. If you do not file this statement,

you may be subject to the penalty provided in section 830 of the

Revenue and Taxation Code. Attached schedules are considered to

be part of the statement. THIS STATEMENT IS SUBJECT TO AUDIT.

SBE No.

MAKE NECESSARY CORRECTIONS TO ADDRESS LABEL

Indicate if above is a change of name and/or address.

NAME AND ADDRESS OF PERSON TO WHOM CORRESPONDENCE

DATE

DATE TO BE

THIS STATEMENT SHALL CONSIST OF:

N/A

SUBMITTED

REGARDING AUDIT SHOULD BE ADDRESSED:

(1) Financial Schedules A through D

NAME

(2) Schedules of Leased Equipment

600-A

600-B

MAILING ADDRESS (including zip code)

(3) Summary Control

(4) Schedule of Intangible Information

TELEPHONE NUMBER

(

)

(5) Tangible Property List

EMAIL ADDRESS

(6) Statement of Land Changes, BOE-551

(7) Statement of Authorization, BOE-892

LOCATION OF ACCOUNTING RECORDS (street, city, state, and zip code)

(8) Other information

(see instructions on reverse)

a. 2012 Annual Report to CPUC

b. 2012 Annual Report to FCC

c. 2012 SEC Form 10K —2 copies

NAME OF AUTHORIZED REPRESENTATIVE (if applicable)

d. 2012 Shareholders Report—3 copies

ADDRESS (street, city, state, and zip code)

e. Franchise Payments for Cable TV

f. Payments to Local Governments in CA

DAYTIME TELEPHONE NUMBER

g. Other information as requested

(

)

EMAIL ADDRESS

* BOE-892, Statement of Authorization, must be filed annually.

List business activities: ________________________________________________________________________________________________________

Has your company taken a FASB write-down to reflect a reduction in the value of your fixed assets?

Yes

If yes, enter the date the write-down was booked __________________________________________________

(4) ENTITY TYPE:

Proprietorship

Partnership

Corporation

Other

Change in ownership prior 12 months?

Yes

CERTIFICATION

I certify (or declare) under penalty of perjury under the laws of the State of California that I have examined this Property Statement, including accompanying schedules

and statements, and to the best of my knowledge and belief it is true, correct, and complete and covers all property required to be reported which is owned, claimed,

possessed, controlled, or managed by the person named in the statement at 12:01 a.m. on January 1, 2013. If prepared by a person other than the taxpayer, this

declaration is based on all information of which preparer has knowledge.

FULL LEGAL NAME OF BUSINESS

FOR OFFICIAL USE ONLY

PRINTED NAME OF SIGNATORY

TITLE

SIGNATURE OF OWNER, PARTNER, OR CORPORATE OFFICER

DATE

2013

SIGNATURE OF AUTHORIZED REPRESENTATIVE

DATE

2013

INFORMATION PROVIDED ON A PROPERTY STATEMENT MAY BE SHARED WITH OTHER STATE BOARD OF EQUALIZATION DEPARTMENTS