Ill. Admin. Code tit. 83, § 255.EXHIBIT C
| (Name of Company in full) | ||||||||||||||||||
| (Date) | ||||||||||||||||||
| Advice No. | ||||||||||||||||||
| To: | Illinois Commerce Commission 527 East Capitol Avenue Springfield, Illinois 62706 | |||||||||||||||||
| The accompany schedule (or revised sheet or additional original sheet), issued by the | ||||||||||||||||||
| company, is transmitted to you for filing. | ||||||||||||||||||
| Ill. C. C. No. | ||||||||||||||||||
| (Original or Revised) | Sheet No. | |||||||||||||||||
| Cancelling | (Original or Revised) | Sheet No. | ||||||||||||||||
| Effective | , 19 | . | ||||||||||||||||
| (See statement in 83 Ill. Adm. Code 255.30(l) as to additional information required.) | ||||||||||||||||||
| (Signature) | ||||||||||||||||||
(Source: Amended at 11 Ill. Reg. 16119, effective October 1, 1987)