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["Federal Communications Commission",null,null,null,"OMB Control Number 3060-0700"]
["Washington, D. C. 20554"]
["FCC FORM 1275"]
["CERTIFICATION FOR OPEN VIDEO SYSTEMS"]
[]
["A.  Company Information"]
["Company Name:"]
[]
["Contact Person:"]
[]
["Mailing Address:"]
[]
["City:",null,null,"State:","Zip Code:"]
[]
["Phone Number:",null,null,"Fax Number:"]
[]
[]
["B.  Attach a statement of ownership, including all affiliated entities"]
[]
["C.  Eligibility and Compliance Representations"]
[{"$nulls":4},"Yes","No","N/A"]
["1.  If you are a cable operator applying for certification within your cable franchise area, are you"]
["qualified to operate an open video system under 47 C.F.R. § 76.1501?"]
["2.  Do you agree to comply and to remain in compliance with each of the Commission's"]
["regulations in 47 C.F.R. §§ 76.1503, 76.1504, 76.1506(m), 76.1508, 76.1509, and 76.1513?"]
["3.  Do you agree to comply with the Commission's notice and enrollment requirements"]
["for unaffiliated video programming providers?"]
["4.  If applicable, do you agree to file changes to your cost allocation manual at least"]
["60 days before the commencement of service?"]
[]
["D.  System Information"]
["1.  Provide a general description of the anticipated communities or areas to be served upon completion of the system."]
{"$rows_empty":8}
["2.  Anticipated Digital Capacity:",null,null,"3.  Anticipated Analog Capacity:"]
["4.  If Switched Digital, Anticipated Number of Channel Input Ports:"]
[]
["E.  Verification Statement"]
["WILLFUL FALSE STATEMENTS MADE ON THIS FORM ARE PUNISHABLE BY FINE AND/OR IMPRISONMENT"]
["(U.S. CODE TITLE 18, SECTION 1001), AND/OR FORFEITURE (U.S. CODE, TITLE 47, SECTION 503)"]
["To the best of my knowledge and belief, the representations made herein are accurate according to the most recent information available."]
["Name:",null,"Signature:"]
[]
["Title:",null,"Date:"]