APPLICATION FOR SPECIAL CERTIFICATE TO OFFER SHARED AND/OR RESOLD (STS) TELEPHONE SERVICE

STS SPECIAL CERTIFICATE NO. ____

Note: To apply for Special Certification, Applicant must submit a filing fee of $25.00 and the typed

original and 8 copies of this document to the Commission at the following address:

Chief Clerk

North Carolina Utilities Commission

4325 Mail Service Center

Raleigh, NC 27699-4325

DATE OF APPLICATION ________________

APPLICANT

_________________________________________________________________________________

(NAME)

_________________________________________________________________________________

(STREET)

_________________________________________________________________________________

(CITY, STATE, ZIP)

TELEPHONE ( ) ___________

ADDRESS AND DESCRIPTION OF PREMISES TO BE SERVED AND SERVICES TO BE OFFERED: (A map may be attached)

REPRESENTATIVE TO WHOM COMPLAINTS SHOULD BE ADDRESSED

_________________________________________________________________________________

(NAME)

_________________________________________________________________________________

(STREET)

_________________________________________________________________________________

(CITY, STATE, ZIP)

TELEPHONE ( )___________________

As the provider of resold and/or shared service, I certify that I have read and agree to abide by the Rules in Chapter 14 of the North Carolina Utilities Commission attached as Appendix A to this Application.

___________________Date

Signature of Applicant__________________________

Title________________________________________

VERIFICATION

STATE OF _________ COUNTY OF _______________

The above‑named _________, personally appeared before me this day and, being first duly sworn, says that the facts stated in the foregoing application and any exhibits, documents, and statements thereto attached are true as he verily believes.

WITNESS my hand and notarial seal, this ____ day of _____, 19__.

________________________

Notary Public

My Commission expires: __________

Chapter 14A.

Sharing and/or Resale of Telephone Service by Colleges and Universities Pursuant to G.S. 62‑110(e).

Rule R14A‑1. Application.

Rule R14A‑2. Definitions.

Rule R14A‑3. Certificate.

Rule R14A‑4. Service which can be shared or resold.

Rule R14A‑5. Contract.

Rule R14A‑6. Local exchange company access.

Rule R14A‑7. Provision of local access lines.

Rule R14A‑8. Networking.

Rule R14A‑9. Quality of service.

Rule R14A‑10. Rating of local service.

Rule R14A‑11. Charges to end‑users.