Document

Form FCC Form 394 FCC Form 394 Application for Franchise Authority Consent to Assignmen

ICR 200903-3060-012 · OMB 3060-0573 · Object 10893101.

⚠️ Notice: This form may be outdated. More recent filings and information on OMB 3060-0573 can be found here:

Document [xlw]

Download: xlw | pdf | html

Overview

Sheet1
Sheet2
Sheet3
Sheet4
Sheet5

Sheet 1: Sheet1

FCC 394

APPLICATION FOR FRANCHISE AUTHORITY

CONSENT TO ASSIGNMENT OR TRANSFER OF CONTROL

OF CABLE TELEVISION FRANCHISE

FOR FRANCHISE AUTHORITY USE ONLY

SECTION I. GENERAL INFORMATION

DATE

1. Community Unit Identification Number:

2. Application for:

Assignment of Franchise

Transfer of Control

3. Franchising Authority:

4. Identify community where the system/franchise that is the subject of the assignment or transfer of control is located:

5. Date system was acquired or (for system's constructed by the transferor/assignor) the date on

which service was provided to the first subscriber in the franchise area:

6. Proposed effective date of closing of the transaction assigning or transferring ownership of the

system to transferee/assignee:

7. Attach as an Exhibit a schedule of any and all additional information or material filed with this

Exhibit No.

application that is identified in the franchise as required to be provided to the franchising

authority when requesting its approval of the type of transaction that is the subject of this

application.

PART I - TRANSFEROR/ASSIGNOR

1. Indicate the name, mailing address, and telephone number of the transferor/assignor.

Legal name of Transferor/Assignor (if individual, list last name first)

Assumed name used for doing business (if any)

Mailing street address or P.O. Box

City

State

ZIP Code

Telephone No. (include area code)

2.(a) Attach as an Exhibit a copy of the contract or agreement that provides for the assignment or

Exhibit No.

transfer of control (including any exhibits or schedules thereto necessary in order to understand the

terms thereof). If there is only an oral agreement, reduce the terms to writing and attach.

(Confidential trade, business, pricing or marketing information, or other information not otherwise

publicly available, may be redacted).

(b) Does the contract submitted in response to (a) above embody the full and complete agreement

Yes

between the transferor/assignor and the transferee/assignee?

If No, explain in an Exhibit.

Exhibit No.

Sheet 2: Sheet2

PART II - TRANSFEREE/ASSIGNEE

1.(a) Indicate the name, mailing address, and telephone number of the transferee/assignee.

Legal name of Transferee/Assignee (if individual, list last name first)

Assumed name used for doing business (if any)

Mailing street address or P.O. Box

City

State

ZIP Code

Telephone No. (include area code)

(b) Indicate the name, mailing address, and telephone number of person to contact, if other than transferee/assignee.

Name of contact person (list last name first)

Firm or company name (if any)

Mailing street address or P.O. Box

City

State

ZIP Code

Telephone No. (include area code)

Exhibit No.

should be contacted, if any.

(d) Indicate the address where the system's records will be maintained.

Street address

City

State

ZIP Code

2. Indicate on an attached exhibit any plans to change the current terms and conditions of service and

Exhibit No.

operations of the system as a consequence of the transaction for which approval is sought.

Sheet 3: Sheet3

SECTION II. TRANSFEREE'S/ASSIGNEE'S LEGAL QUALIFICATIONS


1.	Transferee/Assignee is:

		Corporation	a. Jurisdiction of incorporation:	d. Name and address of registered agent in
				jurisdiction:
			b. Date of incorporation:

			c. For profit or not-for-profit:


		Limited Partnership	a. Jurisdiction in which formed:	c. Name and address of registered agent in
				jurisdiction:

			b. Date of formation:



		General Partnership	a. Jurisdiction whose laws govern formation:	b. Date of formation:


		Individual

		Other. Describe in an Exhibit.			Exhibit No.


2.	List the transferee/assignee, and, if the transferee/assignee is not a natural person, each of its officers, directors, stockholders
	beneficially holding more than 5% of the outstanding voting shares, general partners, and limited partners holding an equity
	interest of more than 5%. Use only one column for each individual or entity. Attach additional pages if necessary. (Read
	carefully - the lettered items below refer to corresponding lines in the following table.)

	(a)	Name, residence, occupation or principal business, and principal place of business. (If other than an individual, also show
	name, address and citizenship of natural person authorized to vote the voting securities of the applicant that it holds.) List the
	applicant first, officers, next, then directors and, thereafter, remaining stockholders and/or partners.
	(b)	Citizenship.
	(c)	Relationship to the transferee/assignee (e.g., officer, director, etc.).
	(d)	Number of shares or nature of partnersihp interest.
	(e)	Number of votes.
	(f )	Percentage of votes.

(a)



(b)
(c)
(d)
(e)
(f )

Sheet 4: Sheet4

If the applicant is a corporation or a limited partnership, is the transferee/assignee formed under the

Yes

laws of, or duly qualified to transact business in, the State or other jurisdiction in which the system

operates?

If the answer is No, explain in an Exhibit.

Exhibit No.

Has the transferee/assignee had any interest in or in connection with an applicant which has been

Yes

dismissed or denied by any franchise authority?

If the answer is Yes, describe circumstances in an Exhibit.

Exhibit No.

Has an adverse finding been made or an adverse final action been taken by any court or

Yes

administrative body with respect to the transferee/assignee in a civil, criminal or administrative

proceeding, brought under the provisions of any law or regulation related to the following: any

felony; revocation, suspension or involuntary transfer of any authorization (including cable

franchises) to provide video programming services; mass media related antitrust or unfair

competition; fraudulent statements to another government unit; or employment discrimination?

If the answer is Yes, attach as an Exhibit a full description of the persons and matter(s) involved,

Exhibit No.

including an identification of any court or administrative body and any proceeding (by dates and file

numbers, if applicable), and the disposition of such proceeding.

Are there any documents, instruments, contracts or understandings relating to ownership or future

Yes

ownership rights with respect to any attributable interest as described in Question 2 (including, but

not limited to, non-voting stock interests, beneficial stock ownership interests, options, warrants,

debentures)?

If Yes, provide particulars in an Exhibit.

Do documents, instruments, agreements or understandings for the pledge of stock of the

Yes

transferee/assignee, as security for loans or contractual performance, provide that: (a) voting rights

will remain with the applicant, even in the event of default on the obligation; (b) in the event of

default, there will be either a private or public sale of the stock; and (c) prior to the exercise of any

ownership rights by a purchaser at a sale described in (b), any prior consent of the FCC and/or of the

franchising authority, if required pursuant to federal, state or local law or pursuant to the terms of

the franchise agreement will be obtained?

If No, attach as an Exhibit a full explanation.

Exhibit No.

SECTION III. TRANSFEREE'S/ASSIGNEE'S FINANCIAL QUALIFICATIONS

The transferee/assignee certifies that it has sufficient net liquid assets on hand or available from

Yes

committed resources to consummate the transaction and operate the facilities for three months.

Attach as an Exhibit the most recent financial statements, prepared in accordance with generally

Exhibit No.

accepted accounting principals, including a balance sheet and income statement for at least one full

year, for the transferee/assignee or parent entity that has been prepared in the ordinary course of

business, if any such financial statements are routinely prepared. Such statements, if not otherwise

publicly available, may be marked CONFIDENTIAL and will be maintained as confidential by the

franchise authority and its agents to the extent permissible under local law.

SECTION IV. TRANSFEREE'S/ASSIGNEE'S TECHNICAL QUALIFICATIONS

Set forth in an Exhibit a narrative account of the transferee's/assignee's technical qualifications, experience

Exhibit No.

and expertise regarding cable television systems, including, but not limited to, summary information about

appropriate management personnel that will be involved in the system's management and operations. The

transferee/assignee may, but need not, list a representative sample of cable systems currently or formerly

owned or operated.

Sheet 5: Sheet5

SECTION V - CERTIFICATIONS

Part I - Transferor/Assignor

All the statements made in the application and attached exhibits are considered material representations, and all the Exhibits

are a material part hereof and are incorporated herein as if set out in full in the application.

Signature

I CERTIFY that the statements in this application are true,

complete and correct to the best of my knowledge and belief and

are made in good faith.

Date

WILLFUL FALSE STATEMENTS MADE ON THIS FORM ARE

PUNISHABLE BY FINE AND/OR IMPRISONMENT. U.S. CODE,

Print full name

TITLE 18, SECTION 1001.

Check appropriate classification:

Individual

General Partner

Corporate Officer (Indicate Title)

Other. Explain:

Part II - Transferee/Assignee

All the statements made in the application and attached Exhibits are considered material representations, and all the Exhibits

are a material part hereof and are incorporated herein as if set out in full in the application.

The transferee/assignee certifies that he/she:

(a) Has a current copy of the FCC's Rules governing cable television systems.

(b) Has a current copy of the franchise that is the subject of this application, and of any applicable state laws or local

ordinances and related regulations.

(c) Will use its best efforts to comply with the terms of the franchise and applicable state laws or local ordinances and related

regulations, and to effect changes, as promptly as practicable, in the operation system, if any changes are necessary to cure

any violations thereof or defaults thereunder presently in effect or ongoing.

Signature

I CERTIFY that the statements in this application are true,

complete and correct to the best of my knowledge and belief and

are made in good faith.

Date

WILLFUL FALSE STATEMENTS MADE ON THIS FORM ARE

PUNISHABLE BY FINE AND/OR IMPRISONMENT. U.S. CODE,

Print full name

TITLE 18, SECTION 1001.

Check appropriate classification:

Individual

General Partner

Corporate Officer (Indicate Title)

Other. Explain:

File Type	application/octet-stream
File Title	Form FCC Form 394 FCC Form 394 Application for Franchise Authority Consent to Assignmen
File Modified	0000-00-00
File Created	0000-00-00