Attachment D

Page 1 of 5

CTV FORM 300

STATEMENT OF REVENUE & EXPENSES

PART A

INCOME STATEMENT

Reporting Entity:CurrentPrior

Franchises Served:YearYear

Year Ending:December 31, 20______

______

OPERATING INCOME

Subscriber Revenues

620Installation Income______

630Equipment Revenue______

640Basic/Other Tier Subscriber Revenue______

650Premium Channel Revenue______

660Pay Per View Revenue______

670Other Subscriber Revenues______

680Total Subscriber Revenues______

Non-Subscriber Revenues

690Advertising Income______

700Other Income______

710Total Non-Subscriber Revenues______

720Total Operating Income______

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Attachment D

Page 2 of 5

CTV FORM 300

STATEMENT OF REVENUE & EXPENSES

PART A

INCOME STATEMENT

Reporting Entity:CurrentPrior

Franchises Served:YearYear

Year Ending:December 31, 20______

______

OPERATING EXPENSES

Direct Operating Expenses

730Programming Expenses______

740Net Bad Debt and Collection Expenses______

750Salaries and Benefits______

760Repairs & Maintenance______

770Light, Heat, Power______

780Pole & Duct Rental______

790Administration-Office and Billing______

800Marketing______

810Local Origination______

820Other______

830Total Operating Expenses______

Depreciation and Amortization

840Depreciation ______

850Amortization______

860Total Depreciation and Amortization______

870Total Expenses______

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Attachment D

Page 4 of 5

CTV FORM 300

STATEMENT OF REVENUE & EXPENSES

PART A

INCOME STATEMENT

Reporting Entity:CurrentPrior

Franchises Served:YearYear

Year Ending:December 31, 20______

______

Other Income and Expenses

880Other Income______

______

______

890Interest Expenses______

900Other ______

910Total Other Income and Expenses______

Provision for Income Tax

920Currently Payable______

930Deferred______

940Total Provision for Income Tax______

Extraordinary Items

950Gain/(Loss) on Sale of Fixed Assets______

960Other Extraordinary Items______

970Total Extraordinary Items______

980Net Income______

CTV FORM 300

STATEMENT OF REVENUE & EXPENSES

PART B

STATEMENT OF GROSS ANNUAL RECEIPTS

Description of Gross Annual Receipts

The amount to be reported as gross annual receipts is the total of all revenues earned (reduced by anticipated bad debts) from cable television activity in the Commonwealth. These revenues should include all income from the basic service tier, cable programming service tiers, premium and pay-per-view channels, the rental of converters and remote controls, installations, advertising, local origination, leased access, rentals and management fees.

The amount reported should reflect the total operating income amount reported in the company’s general ledger account. These accounts are included in the operating income accounts set forth in the Cable Division’s Uniform Reporting System - Rules for Completing Financial Reporting Forms. (Total Gross Annual Receipts should equal the total provided on Line 720 of Form 300 for all forms filed by the cable operator.)

Operator:

Address:

I hereby certify that the amount shown below is the gross annual receipts for this company for the calendar year as defined below.

Year: ______Gross annual receipts: $______

______

(Name - Print) (Date)

______

(Name - Signature)(Telephone)

______

(Title)

2/8/01

Attachment D

Page 5 of 5

CTV FORM 300 - STATEMENT OF REVENUE & EXPENSES

PART B - STATEMENT OF GROSS ANNUAL RECEIPTS

Systems Included In Report

Please provide a breakdown of each reporting unit (franchise, system or legal entity) and the corresponding gross receipt amount for each. The total of all the units should comprise the total gross annual receipts amount reported on the previous page.

Reporting UnitGross Receipts for Reporting Unit

Total Gross Receipts* $ ______

* This figure must equal the gross annual receipts figure shown on page 4 above.

2/8/01