Form CF 04 Application to Amend a State-Issued Certificate of Franchise Authority for Cable and/Or Video Service - Florida

Form CF04 is a Florida Department of State (Secretary of State) form also known as the "Application To Amend A State-issued Certificate Of Franchise Authority For Cable And/or Video Service". The latest edition of the form was released in May 1, 2017 and is available for digital filing.

Download an up-to-date Form CF04 in PDF-format down below or look it up on the Florida Department of State (Secretary of State) Forms website.

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INSTRUCTIONS FOR AMENDING AN EXISTING STATE-ISSUED
CERTIFICATE OF FRANCHISE AUTHORITY
It is recommended that you read Chapter 610, Florida Statutes, before amending
an existing State-Issued Certificate of Franchise Authority
1.
Enter the name of the Franchise Certificate holder as it is reflected in the records of
the Department of State.
2.
Enter the current address of the Franchise Certificate holder.
3a.
Enter the description of the new service area and the date of commencement of
operations in compliance with s.610.104(2)(e)5, F.S. A new service area should be
reported within 5 business days after first providing service.
3b.
If there has been a transfer of interest, within 14 business days following completion of
the transfer, enter the name and address of the successor in interest.
3c.
If the contact person’s name and/or address has changed, please enter the name of the
new contact person and/or the address for purposes of service of process.
3d.
If a Cable Provider Terminates its entire service area, enter the effective date the service
was terminated in the space provider. The State-Issued Certificate of Franchise Authority
will be terminated.
Mail amendment form with a check in the amount of $35.00 made payable to the Department of
State to one of the addresses below.
MAILING ADDRESS:
OVERNIGHT COURIER:
Cable and/or Video Franchising
Cable and/or Video Franchising
Division of Corporations
Division of Corporations
PO Box 6327
Clifton Building
Tallahassee, Florida 32314
2661 Executive Center Circle
Tallahassee, Florida 32301
Any further inquiries concerning this matter should be directed to the Cable and/or Video
Franchising Section by calling (850) 245-6010 between the hours of 8:00am- 5:00pm or
writing to the address above.
INSTRUCTIONS FOR AMENDING AN EXISTING STATE-ISSUED
CERTIFICATE OF FRANCHISE AUTHORITY
It is recommended that you read Chapter 610, Florida Statutes, before amending
an existing State-Issued Certificate of Franchise Authority
1.
Enter the name of the Franchise Certificate holder as it is reflected in the records of
the Department of State.
2.
Enter the current address of the Franchise Certificate holder.
3a.
Enter the description of the new service area and the date of commencement of
operations in compliance with s.610.104(2)(e)5, F.S. A new service area should be
reported within 5 business days after first providing service.
3b.
If there has been a transfer of interest, within 14 business days following completion of
the transfer, enter the name and address of the successor in interest.
3c.
If the contact person’s name and/or address has changed, please enter the name of the
new contact person and/or the address for purposes of service of process.
3d.
If a Cable Provider Terminates its entire service area, enter the effective date the service
was terminated in the space provider. The State-Issued Certificate of Franchise Authority
will be terminated.
Mail amendment form with a check in the amount of $35.00 made payable to the Department of
State to one of the addresses below.
MAILING ADDRESS:
OVERNIGHT COURIER:
Cable and/or Video Franchising
Cable and/or Video Franchising
Division of Corporations
Division of Corporations
PO Box 6327
Clifton Building
Tallahassee, Florida 32314
2661 Executive Center Circle
Tallahassee, Florida 32301
Any further inquiries concerning this matter should be directed to the Cable and/or Video
Franchising Section by calling (850) 245-6010 between the hours of 8:00am- 5:00pm or
writing to the address above.
APPLICATION TO AMEND A STATE-ISSUED CERTIFICATE OF FRANCHISE
AUTHORITY FOR CABLE AND/OR VIDEO SERVICE
1)
Name of Certificate holder________________________________________
2)
Address of Certificate holder: ________________________________________
3)
Statement of Amendment(s):
__
a) Change in Service Area. Notification of Commencement is required within five
business days after first providing service in each additional areas. Please
provide a description of the new service area consistent with s.610.104(2)(e)5
Florida Statutes, and effective date of Commencement of Operations. (Please
include all service areas.) List existing areas first and new areas last. Use
attached pages if necessary
__
b) Notice of Transfer of Interest. Notification is required within fourteen business
days following completion of transfer. Please provide the name and address of
any successor in interest.
__
c) Other: (change of address or contact person)
__
d) Notice to Terminate Service.
Effective Date:______________________
_______________________________________ _____________________ _________
Printed Name and Title
Signature
Date
Division of Corporations, Cable and/or Video Franchising
PO Box 6327, Tallahassee, Florida 32314
CF04(05/17)

Download Form CF 04 Application to Amend a State-Issued Certificate of Franchise Authority for Cable and/Or Video Service - Florida

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