APPENDIX A: NOTICE OF INTENT

   Date

Elkhart County Commissioners

County Administration Bldg.

117 N. Second Street

Goshen, IN 46526

RE: Cable Television Franchise Ordinance

Dear Honorable Commissioners:

Pursuant to the County Cable Television Franchise Ordinance, this letter shall serve as our notice of intent to accept the franchise granted and to comply with the terms and provisions of the Ordinance. Our legal name and address as franchisee are as follows:

Name of Franchisee:                                                                                 

Address:                                                                                                  

For purposes of the Ordinance, notices and responses to the franchisee shall be directed as follows:

Name:                                                                                                      

Address:                                                                                                  

With a copy to:                                                                                        

This notice of intent shall be effective on the         day of                     , 20     . Our initial annual franchise fee of three hundred dollars ($300.00) payable to the County of Elkhart, Indiana (is enclosed) or (will be sent under separate cover).

                  Sincerely,

                  Name of franchisee

                  By:                                                                                           

                  Title:                                                                                        

cc:   Elkhart County Attorney

   130 N. Main Street

   Goshen, IN 46526

(Ord. 04-61, passed 2-2-2004, 2004 COM REC 61–71)