Form BOE-517-FF Fillable Schedule of Franchise Fee Payments
(all forms fillable on Windows, Mac, Android tablets, and iPad using Adobe Reader XI)

( Column B County Name) (CLEAR) CLEAR (Column B County Name) (Column B County Name) (Column B County Name) (Column B County Name) (Column B County Name) (Column B County Name) (Column B County Name) (Column B County Name) (Column B County Name) (Column B County Name) (Column C Calendar year 2012 Cable and Video Service Franchise Fee Payments) (Column C Calendar year 2012 Cable and Video Service Franchise Fee Payments) (Column C Calendar year 2012 Cable and Video Service Franchise Fee Payments) (Column C Calendar year 2012 Cable and Video Service Franchise Fee Payments) (Column C Calendar year 2012 Cable and Video Service Franchise Fee Payments) (Column C Calendar year 2012 Cable and Video Service Franchise Fee Payments) (Column C Calendar year 2012 Cable and Video Service Franchise Fee Payments) (Column C Calendar year 2012 Cable and Video Service Franchise Fee Payments) (Column C Calendar year 2012 Cable and Video Service Franchise Fee Payments) (Column C Calendar year 2012 Cable and Video Service Franchise Fee Payments) (Column D Contract Commencement Date) (Column D Contract Commencement Date) (Column D Contract Commencement Date) (Column D Contract Commencement Date) (Column D Contract Commencement Date) (Column D Contract Commencement Date) (Column D Contract Commencement Date) (Column D Contract Commencement Date) (Column D Contract Commencement Date) (Column D Contract Commencement Date) (Column E Contract Termination Date) (Column E Contract Termination Date) (Column E Contract Termination Date) (Column E Contract Termination Date) (Column E Contract Termination Date) (Column E Contract Termination Date) (Column E Contract Termination Date) (Column E Contract Termination Date) (Column E Contract Termination Date) (Column E Contract Termination Date) (Column F Franchisee Name) (Column F Franchisee Name) (Column F Franchisee Name) (Column F Franchisee Name) (Column F Franchisee Name) (Column F Franchisee Name) (Column F Franchisee Name) (Column F Franchisee Name) (Column F Franchisee Name) (Column F Franchisee Name) (Company Name) (PRINT) PRINT (Row 1 Column A County Number) (Row 10 Column A County Number) (Row 11 Column A County Number) (Row 12 Column A County Number) (Row 13 Column A County Number) (Row 14 Column A County Number) (Row 15 Column A County Number) (Row 16 Column A County Number) (Row 17 Column A County Number) (Row 18 Column A County Number) (Row 19 Column A County Number) (Row 2 Column A County Number) (Row 20 Column A County Number) (Row 3 Column A County Number) (Row 4 Column A County Number) (Row 5 Column A County NumberRow ) (Row 6 Column A County Number) (Row 7 Column A County Number) (Row 8 Column A County Number) (Row 9 Column A County Number) (SBE NO ) ACOUNTY NUMBERBCOUNTY NAMECCALENDAR YEAR 2012CABLE AND VIDEO SERVICE BOE 517 FF (FRONT) REV 5 (12 12) COMPANY NAME FRANCHISE FEE PAYMENTSDCONTRACTCOMMENCEMENTDATEECONTRACTTERMINATIONDATEFFRANCHISE NAME Please read instructions on reverse before preparing this schedule SBE NO SCHEDULE OF FRANCHISE FEE PAYMENTSBOARD OF EQUALIZATION STATE OF CALIFORNIA