Application For A State Issued Certificate Of Franchise Authority - South Carolina Secretary Of State

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STATE OF SOUTH CAROLINA
SECRETARY OF STATE
APPLICATION FOR A STATE-ISSUED
CERTIFICATE OF FRANCHISE AUTHORITY
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 S.C. Code Section 58-12-310, the undersigned hereby applies for authorization to
provide cable or video service in the state of South Carolina.
1.
The name of the applicant is
□
□
2.
The applicant is providing
Cable Service
OR
Video Service
3.
The street address of the applicant is
Street Address
City
County
State
Zip Code
The mailing address of the applicant is
4.
The municipalities and unincorporated areas of counties that are proposed to be served by the
applicant are to be described in the accompanying Affidavit in Support of State-Issued Certificate
of Franchise Authority. For each of the municipalities and unincorporated areas of counties so
described, provide the name, address and telephone number for the person to whom the Notice
of Application for a State-Issued Certificate of Franchise Authority should be provided.
Expiration Date of
Current Franchise
Municipality/Area
Name & Title
Address
Telephone No.
(if applicable)

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