**Application Form 532**

**Rural Development**

**United States Department of Agriculture**

**RURAL DEVELOPMENT, UTILITIES PROGRAMS (RURAL DEVELOPMENT)**

**RUS Form 532 & Schedules**

***Rural Broadband Access Loan and***

***Loan Guarantee Application***

![](media/image1.png){width="3.564583333333333in"
height="2.7506944444444446in"}

**[Submit Applications to Your Rural Development General Field
Representative or to Washington Broadband Office at:]{.smallcaps}**

KENNETH KUCHNO

BROADBAND DIVISION

TELECOMMUNICATIONS PROGRAM

RURAL DEVELOPMENT, UTILITIES PROGRAMS

U.S. DEPARTMENT OF AGRICULTURE

STOP 1599, ROOM 2844-S

1400 INDEPENDENCE AVENUE, SW

WASHINGTON, DC 20250-1599

**For reference see our website**

<http://www.usda.gov/rus/telecom/broadband.htm>

Issue Date June 17, 2004

*According to the Paperwork Reduction Act of 1995, an agency may not
conduct or sponsor, and a person is not required to respond to, a
collection of information unless it displays a valid OMB control number.
The valid OMB control number for this information collection is
0572‑0130. The time required to complete this information collection is
estimated to average 90 hours per response, including the time for
reviewing instructions, searching existing data sources, gathering and
maintaining the data needed, and completing and reviewing the collection
of information.*

+-----------------------------------+---+---+----------------+---+-------------+
| United States Department of       |   | * |                |   |             |
| Agriculture                       |   | * |                |   |             |
|                                   |   | R |                |   |             |
| Rural Development, Utilities      |   | U |                |   |             |
| Programs                          |   | R |                |   |             |
|                                   |   | A |                |   |             |
| **[Application For                |   | L |                |   |             |
| Broadband]{.smallcaps}**          |   | D |                |   |             |
|                                   |   | E |                |   |             |
| **[Loan or Loan                   |   | V |                |   |             |
| Guarantee]{.smallcaps}**          |   | E |                |   |             |
|                                   |   | L |                |   |             |
|                                   |   | O |                |   |             |
|                                   |   | P |                |   |             |
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+-----------------------------------+---+---+----------------+---+-------------+
| 1\. NAME & ADDRESS OF APPLICANT:  |   | 2 |                |   |             |
|                                   |   | \ |                |   |             |
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+-----------------------------------+---+---+----------------+---+-------------+
| 3\. PHONE NUMBER:                 |   | 4 |                |   |             |
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+-----------------------------------+---+---+----------------+---+-------------+
| 5\. E-MAIL ADDRESS:               |   | 6 |                |   |             |
|                                   |   | \ |                |   |             |
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+-----------------------------------+---+---+----------------+---+-------------+
| 7\. TYPE OF ORGANIZATION (Check   |   | 8 |                | 9 |             |
| one):                             |   | \ |                | \ |             |
|                                   |   | . |                | . |             |
| Corporation LLC                   |   | T |                | R |             |
|                                   |   | Y |                | E |             |
| Cooperative or Mutual Indian      |   | P |                | F |             |
| Tribe                             |   | E |                | I |             |
|                                   |   | o |                | N |             |
| Public Body Other                 |   | f |                | A |             |
| \_\_\_\_\_\_\_\_                  |   | L |                | N |             |
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+-----------------------------------+---+---+----------------+---+-------------+
| 10\. PURPOSE OF LOAN (Briefly     |   |   |                |   |             |
| explain the purposes for which    |   |   |                |   |             |
| loan funds are intended and the   |   |   |                |   |             |
| amount required for each          |   |   |                |   |             |
| purpose):                         |   |   |                |   |             |
+-----------------------------------+---+---+----------------+---+-------------+
| 11\. LOAN MATURITY REQUESTED      |   | 1 |                |   |             |
| (Check one):                      |   | 2 |                |   |             |
|                                   |   | \ |                |   |             |
| Composite Economic Life of        |   | . |                |   |             |
| Facilities Financed               |   | A |                |   |             |
|                                   |   | M |                |   |             |
| \_\_\_\_\_ years (if less than    |   | O |                |   |             |
| composite economic life)          |   | U |                |   |             |
|                                   |   | N |                |   |             |
|                                   |   | T |                |   |             |
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+-----------------------------------+---+---+----------------+---+-------------+
| 13\. EMPLOYER TAX IDENTIFICATION  |   | 1 |                |   |             |
| NO. (TIN):                        |   | 4 |                |   |             |
|                                   |   | \ |                |   |             |
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+-----------------------------------+---+---+----------------+---+-------------+
| 15\. CONGRESSIONAL DISTRICTS      |   | > |                |   |             |
| (Attach as Schedule A):           |   |   |                |   |             |
|                                   |   | 1 |                |   |             |
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|                                   |   | 2 |                |   |             |
|                                   |   | ) |                |   |             |
|                                   |   | : |                |   |             |
+-----------------------------------+---+---+----------------+---+-------------+
| > Page 1 of 3 RUS FORM 532        |   |   |                |   |             |
+-----------------------------------+---+---+----------------+---+-------------+
| 17\. COMPLIANCE CERTIFICATES      |   |   |                |   |             |
| (Print and sign the samples       |   |   |                |   |             |
| provided):                        |   |   |                |   |             |
|                                   |   |   |                |   |             |
| A. EQUAL OPPORTUNITY AND          |   |   |                |   |             |
| NONDISCRIMINATION CERTIFICATION   |   |   |                |   |             |
| (Attach as Schedule C-1):         |   |   |                |   |             |
|                                   |   |   |                |   |             |
| B. CERTIFICATION REGARDING        |   |   |                |   |             |
| ARCHITECTURAL BARRIERS (Attach as |   |   |                |   |             |
| Schedule C-2):                    |   |   |                |   |             |
|                                   |   |   |                |   |             |
| C. CERTIFICATION REGARDING FLOOD  |   |   |                |   |             |
| HAZARD AREA PRECAUTIONS (Attach   |   |   |                |   |             |
| as Schedule C-3):                 |   |   |                |   |             |
|                                   |   |   |                |   |             |
| D. UNIFORM RELOCATION ASSISTANCE  |   |   |                |   |             |
| & REAL PROPERTY ACQUISITION       |   |   |                |   |             |
| POLICIES (Attach as Schedule      |   |   |                |   |             |
| C-4):                             |   |   |                |   |             |
|                                   |   |   |                |   |             |
| E. CERTIFICATION REGARDING        |   |   |                |   |             |
| DEBARMENT, SUSPENSION, AND OTHER  |   |   |                |   |             |
| RESPONSIBILITY MATTERS PRIMARY    |   |   |                |   |             |
| COVERED TRANSACTIONS (Attach as   |   |   |                |   |             |
| Schedule C-5):                    |   |   |                |   |             |
|                                   |   |   |                |   |             |
| F. CERTIFICATION REGARDING        |   |   |                |   |             |
| LOBBYING FOR CONTRACTS, GRANTS,   |   |   |                |   |             |
| LOANS, AND COOPERATIVE AGREEMENTS |   |   |                |   |             |
| (Attach as Schedule C-6):         |   |   |                |   |             |
|                                   |   |   |                |   |             |
| G. ENVIRONMENTAL IMPACT           |   |   |                |   |             |
| CERTIFICATION (Attach as Schedule |   |   |                |   |             |
| C-7):                             |   |   |                |   |             |
|                                   |   |   |                |   |             |
| H. SYSTEM DESIGN CERTIFICATION    |   |   |                |   |             |
| (Attach as Schedule C-8):         |   |   |                |   |             |
+-----------------------------------+---+---+----------------+---+-------------+
| 18\. COMMUNITIES:                 |   | 1 |                |   |             |
|                                   |   | 9 |                |   |             |
| A. EXISTING AND PROPOSED          |   | \ |                |   |             |
| COMMUNITIES (Attach as Schedule   |   | . |                |   |             |
| D-1 following the sample          |   | C |                |   |             |
| provided):                        |   | E |                |   |             |
|                                   |   | R |                |   |             |
| B. EXISTING SERVICE PROVIDERS     |   | T |                |   |             |
| (Attach as Schedule D-2 following |   | I |                |   |             |
| the sample provided):             |   | F |                |   |             |
|                                   |   | I |                |   |             |
| C. SERVICE AREA MAPS (Attach as   |   | C |                |   |             |
| Schedule D-3):                    |   | A |                |   |             |
|                                   |   | T |                |   |             |
|                                   |   | I |                |   |             |
|                                   |   | O |                |   |             |
|                                   |   | N |                |   |             |
|                                   |   | O |                |   |             |
|                                   |   | F |                |   |             |
|                                   |   | B |                |   |             |
|                                   |   | R |                |   |             |
|                                   |   | O |                |   |             |
|                                   |   | A |                |   |             |
|                                   |   | D |                |   |             |
|                                   |   | B |                |   |             |
|                                   |   | A |                |   |             |
|                                   |   | N |                |   |             |
|                                   |   | D |                |   |             |
|                                   |   | A |                |   |             |
|                                   |   | V |                |   |             |
|                                   |   | A |                |   |             |
|                                   |   | I |                |   |             |
|                                   |   | L |                |   |             |
|                                   |   | A |                |   |             |
|                                   |   | B |                |   |             |
|                                   |   | I |                |   |             |
|                                   |   | L |                |   |             |
|                                   |   | I |                |   |             |
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|                                   |   | l |                |   |             |
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|                                   |   | i |                |   |             |
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|                                   |   | p |                |   |             |
|                                   |   | l |                |   |             |
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|                                   |   | d |                |   |             |
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|                                   |   | d |                |   |             |
|                                   |   | ) |                |   |             |
|                                   |   | : |                |   |             |
+-----------------------------------+---+---+----------------+---+-------------+
| 20\. NOTICE OF PROPOSED SERVICE:  |   | 2 |                |   |             |
|                                   |   | 1 |                |   |             |
| A. PROOF OF LEGAL NOTICE (Attach  |   | \ |                |   |             |
| as Schedule F-1 following the     |   | . |                |   |             |
| sample provided):                 |   | C |                |   |             |
|                                   |   | O |                |   |             |
| B. SUFFICIENCY OF LEGAL NOTICE    |   | R |                |   |             |
| (Attach as Schedule F-2):         |   | P |                |   |             |
|                                   |   | O |                |   |             |
|                                   |   | R |                |   |             |
|                                   |   | A |                |   |             |
|                                   |   | T |                |   |             |
|                                   |   | E |                |   |             |
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|                                   |   | 5 |                |   |             |
|                                   |   | ) |                |   |             |
|                                   |   | : |                |   |             |
+-----------------------------------+---+---+----------------+---+-------------+
| 22\. EXECUTIVE SUMMARY (Attach as |   | 2 |                |   |             |
| Schedule H):                      |   | 3 |                |   |             |
|                                   |   | \ |                |   |             |
|                                   |   | . |                |   |             |
|                                   |   | C |                |   |             |
|                                   |   | R |                |   |             |
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|                                   |   | D |                |   |             |
|                                   |   | I |                |   |             |
|                                   |   | T |                |   |             |
|                                   |   | S |                |   |             |
|                                   |   | U |                |   |             |
|                                   |   | P |                |   |             |
|                                   |   | P |                |   |             |
|                                   |   | O |                |   |             |
|                                   |   | R |                |   |             |
|                                   |   | T |                |   |             |
|                                   |   | ( |                |   |             |
|                                   |   | A |                |   |             |
|                                   |   | t |                |   |             |
|                                   |   | t |                |   |             |
|                                   |   | a |                |   |             |
|                                   |   | c |                |   |             |
|                                   |   | h |                |   |             |
|                                   |   | a |                |   |             |
|                                   |   | s |                |   |             |
|                                   |   | S |                |   |             |
|                                   |   | c |                |   |             |
|                                   |   | h |                |   |             |
|                                   |   | e |                |   |             |
|                                   |   | d |                |   |             |
|                                   |   | u |                |   |             |
|                                   |   | l |                |   |             |
|                                   |   | e |                |   |             |
|                                   |   | I |                |   |             |
|                                   |   | ) |                |   |             |
|                                   |   | : |                |   |             |
+-----------------------------------+---+---+----------------+---+-------------+
| 24\. BOARD RESOLUTION (Attach as  |   |   |                |   |             |
| Schedule J):                      |   |   |                |   |             |
+-----------------------------------+---+---+----------------+---+-------------+
| ***IMPORTANT: If you believe the  |   |   |                |   |             |
| following information contained   |   |   |                |   |             |
| in Schedules K through U-2 is     |   |   |                |   |             |
| Business Proprietary Information, |   |   |                |   |             |
| pursuant to Executive Order       |   |   |                |   |             |
| 12600, please indicate so at the  |   |   |                |   |             |
| top of each page.***              |   |   |                |   |             |
+-----------------------------------+---+---+----------------+---+-------------+
| 25\. RESEARCH DATA & MARKET       |   | 2 |                |   |             |
| ANALYSIS                          |   | 6 |                |   |             |
|                                   |   | \ |                |   |             |
| A. RESEARCH DATA (Attach as       |   | . |                |   |             |
| Schedule K-1):                    |   | B |                |   |             |
|                                   |   | U |                |   |             |
| B. MARKET ANALYSIS (Attach as     |   | S |                |   |             |
| Schedule K-2):                    |   | I |                |   |             |
|                                   |   | N |                |   |             |
|                                   |   | E |                |   |             |
|                                   |   | S |                |   |             |
|                                   |   | S |                |   |             |
|                                   |   | P |                |   |             |
|                                   |   | L |                |   |             |
|                                   |   | A |                |   |             |
|                                   |   | N |                |   |             |
|                                   |   | ( |                |   |             |
|                                   |   | A |                |   |             |
|                                   |   | t |                |   |             |
|                                   |   | t |                |   |             |
|                                   |   | a |                |   |             |
|                                   |   | c |                |   |             |
|                                   |   | h |                |   |             |
|                                   |   | a |                |   |             |
|                                   |   | s |                |   |             |
|                                   |   | S |                |   |             |
|                                   |   | c |                |   |             |
|                                   |   | h |                |   |             |
|                                   |   | e |                |   |             |
|                                   |   | d |                |   |             |
|                                   |   | u |                |   |             |
|                                   |   | l |                |   |             |
|                                   |   | e |                |   |             |
|                                   |   | L |                |   |             |
|                                   |   | ) |                |   |             |
|                                   |   | : |                |   |             |
+-----------------------------------+---+---+----------------+---+-------------+
| 27\. MANAGEMENT AND COMPENSATION  |   |   |                |   |             |
| (Attach as Schedule M):           |   |   |                |   |             |
+-----------------------------------+---+---+----------------+---+-------------+
| 28\. FINANCIAL POSITION:          |   |   |                |   |             |
|                                   |   |   |                |   |             |
| A. HISTORICAL FINANCIAL           |   |   |                |   |             |
| STATEMENTS for last three years   |   |   |                |   |             |
| with full footnotes & disclosures |   |   |                |   |             |
| (Attach as Schedules N-1)         |   |   |                |   |             |
|                                   |   |   |                |   |             |
| (Certified financial statements   |   |   |                |   |             |
| are required if available):       |   |   |                |   |             |
|                                   |   |   |                |   |             |
| B. SUBSCRIBER PROJECTION TABLES   |   |   |                |   |             |
| (Attach as Schedule N-2):         |   |   |                |   |             |
|                                   |   |   |                |   |             |
| C. PRO-FORMA 5 YR. FINANCIAL      |   |   |                |   |             |
| FORECAST (Attach as Schedule      |   |   |                |   |             |
| N-3):                             |   |   |                |   |             |
|                                   |   |   |                |   |             |
| D. DEPRECIATION SCHEDULE (Attach  |   |   |                |   |             |
| as Schedule N-4):                 |   |   |                |   |             |
|                                   |   |   |                |   |             |
| E. TOTAL OUTSTANDING INDEBTEDNESS |   |   |                |   |             |
| (Attach breakdown as Schedule     |   |   |                |   |             |
| N-5):                             |   |   |                |   |             |
+-----------------------------------+---+---+----------------+---+-------------+
| 29\. SYSTEM DESIGN (Attach as     | 3 |   |                |   |             |
| Schedule O):                      | 0 |   |                |   |             |
|                                   | \ |   |                |   |             |
|                                   | . |   |                |   |             |
|                                   | N |   |                |   |             |
|                                   | E |   |                |   |             |
|                                   | T |   |                |   |             |
|                                   | W |   |                |   |             |
|                                   | O |   |                |   |             |
|                                   | R |   |                |   |             |
|                                   | K |   |                |   |             |
|                                   | D |   |                |   |             |
|                                   | I |   |                |   |             |
|                                   | A |   |                |   |             |
|                                   | G |   |                |   |             |
|                                   | R |   |                |   |             |
|                                   | A |   |                |   |             |
|                                   | M |   |                |   |             |
|                                   | S |   |                |   |             |
|                                   | ( |   |                |   |             |
|                                   | A |   |                |   |             |
|                                   | t |   |                |   |             |
|                                   | t |   |                |   |             |
|                                   | a |   |                |   |             |
|                                   | c |   |                |   |             |
|                                   | h |   |                |   |             |
|                                   | a |   |                |   |             |
|                                   | s |   |                |   |             |
|                                   | S |   |                |   |             |
|                                   | c |   |                |   |             |
|                                   | h |   |                |   |             |
|                                   | e |   |                |   |             |
|                                   | d |   |                |   |             |
|                                   | u |   |                |   |             |
|                                   | l |   |                |   |             |
|                                   | e |   |                |   |             |
|                                   | P |   |                |   |             |
|                                   | ) |   |                |   |             |
|                                   | : |   |                |   |             |
+-----------------------------------+---+---+----------------+---+-------------+
| Page 2 of 3 RUS FORM 532          |   |   |                |   |             |
+-----------------------------------+---+---+----------------+---+-------------+
| 31\. PROJECT COSTS:               |   |   |                |   |             |
|                                   |   |   |                |   |             |
| SUMMARY OF PROJECT COSTS = Total  |   |   |                |   |             |
| from Details (Attach as Schedule  |   |   |                |   |             |
| Q-1)                              |   |   |                |   |             |
| **\$\_\_\_\_\_\_\_\_\_\_\_\_\_**  |   |   |                |   |             |
|                                   |   |   |                |   |             |
| SUMMARY OF PROJECT COSTS BY YEAR  |   |   |                |   |             |
| (Attach as Schedule Q-1a)         |   |   |                |   |             |
|                                   |   |   |                |   |             |
| > DETAILS:                        |   |   |                |   |             |
|                                   |   |   |                |   |             |
| NETWORK & ACCESS EQUIPMENT -      |   |   |                |   |             |
| (Attach as Schedule Q-2) \$       |   |   |                |   |             |
| \_\_\_\_\_\_\_\_\_\_\_\_\_        |   |   |                |   |             |
|                                   |   |   |                |   |             |
| OUTSIDE PLANT - (Attach as        |   |   |                |   |             |
| Schedule Q-3) \$                  |   |   |                |   |             |
| \_\_\_\_\_\_\_\_\_\_\_\_\_        |   |   |                |   |             |
|                                   |   |   |                |   |             |
| BUILDINGS - (Attach as Schedule   |   |   |                |   |             |
| Q-4) \$                           |   |   |                |   |             |
| \_\_\_\_\_\_\_\_\_\_\_\_\_        |   |   |                |   |             |
|                                   |   |   |                |   |             |
| LAND - (Attach as Schedule Q-5)   |   |   |                |   |             |
| \$ \_\_\_\_\_\_\_\_\_\_\_\_\_     |   |   |                |   |             |
|                                   |   |   |                |   |             |
| TOWERS - (Attach as Schedule Q-6) |   |   |                |   |             |
| \$ \_\_\_\_\_\_\_\_\_\_\_\_\_     |   |   |                |   |             |
|                                   |   |   |                |   |             |
| CUSTOMER PREMISE EQUIPMENT -      |   |   |                |   |             |
| (Attach as Schedule Q-7) \$       |   |   |                |   |             |
| \_\_\_\_\_\_\_\_\_\_\_\_\_        |   |   |                |   |             |
|                                   |   |   |                |   |             |
| OPERATING EQUIPMENT - (Attach as  |   |   |                |   |             |
| Schedule Q-8) \$                  |   |   |                |   |             |
| \_\_\_\_\_\_\_\_\_\_\_\_\_        |   |   |                |   |             |
|                                   |   |   |                |   |             |
| ENGINEERING - (Attach as Schedule |   |   |                |   |             |
| Q-9) \$                           |   |   |                |   |             |
| \_\_\_\_\_\_\_\_\_\_\_\_\_        |   |   |                |   |             |
|                                   |   |   |                |   |             |
| REFINANCING (If Applicable) -     |   |   |                |   |             |
| (Attach as Schedule Q-10) \$      |   |   |                |   |             |
| \_\_\_\_\_\_\_\_\_\_\_\_\_        |   |   |                |   |             |
|                                   |   |   |                |   |             |
| ACQUISITION (If Applicable) -     |   |   |                |   |             |
| (Attach as Schedule Q-11) \$      |   |   |                |   |             |
| \_\_\_\_\_\_\_\_\_\_\_\_\_        |   |   |                |   |             |
+-----------------------------------+---+---+----------------+---+-------------+
| 32\. ENVIRONMENTAL REPORT (Attach |   |   | 33\. TOWER,    |   |             |
| as Schedule R):                   |   |   | EQUIPMENT, AND |   |             |
|                                   |   |   | BUILDING       |   |             |
|                                   |   |   | LEASES (Attach |   |             |
|                                   |   |   | as Schedule    |   |             |
|                                   |   |   | S):            |   |             |
+-----------------------------------+---+---+----------------+---+-------------+
| 34\. LICENSES AND AGREEMENTS:     |   |   |                |   |             |
|                                   |   |   |                |   |             |
| A. FCC LICENSES (Attach as        |   |   |                |   |             |
| Schedule T-1):                    |   |   |                |   |             |
|                                   |   |   |                |   |             |
| B. CLEC LICENSES (Attach as       |   |   |                |   |             |
| Schedule T-2):                    |   |   |                |   |             |
|                                   |   |   |                |   |             |
| C. FRANCHISE AGREEMENTS (Attach   |   |   |                |   |             |
| as Schedule T-3):                 |   |   |                |   |             |
|                                   |   |   |                |   |             |
| D. INTERCONNECTION AGREEMENTS     |   |   |                |   |             |
| (Attach as Schedule T-4):         |   |   |                |   |             |
|                                   |   |   |                |   |             |
| E. MANAGEMENT / SERVICE           |   |   |                |   |             |
| AGREEMENTS (Attach as Schedule    |   |   |                |   |             |
| T-5):                             |   |   |                |   |             |
|                                   |   |   |                |   |             |
| F. BYLAWS or OPERATING AGREEMENT  |   |   |                |   |             |
| (Attach as Schedule T-6):         |   |   |                |   |             |
|                                   |   |   |                |   |             |
| G. OTHER MAJOR AGREEMENTS (Attach |   |   |                |   |             |
| as Schedule T-7):                 |   |   |                |   |             |
+-----------------------------------+---+---+----------------+---+-------------+
| 35\. GUARANTEED LOANS (Loan       |   |   |                |   |             |
| Guarantee Applicants only):       |   |   |                |   |             |
|                                   |   |   |                |   |             |
| A. LENDER INFORMATION (Attach as  |   |   |                |   |             |
| Schedule U-1):                    |   |   |                |   |             |
|                                   |   |   |                |   |             |
| B. LOAN CONTRACT (Attach as       |   |   |                |   |             |
| Schedule U-2):                    |   |   |                |   |             |
+-----------------------------------+---+---+----------------+---+-------------+
| 36\. IS THE BORROWER DELINQUENT   |   |   |                |   |             |
| ON ANY FEDERAL DEBT Examples of   |   |   |                |   |             |
| debts include, but are not        |   |   |                |   |             |
| limited to, delinquent taxes,     |   |   |                |   |             |
| guaranteed or direct government   |   |   |                |   |             |
| loans (more than 31 days past     |   |   |                |   |             |
| due) and other administrative     |   |   |                |   |             |
| debts.                            |   |   |                |   |             |
|                                   |   |   |                |   |             |
| No                                |   |   |                |   |             |
|                                   |   |   |                |   |             |
| Yes (If yes attach explanation)   |   |   |                |   |             |
|                                   |   |   |                |   |             |
| The Federal Government is         |   |   |                |   |             |
| authorized by law to take any or  |   |   |                |   |             |
| all of the following actions in   |   |   |                |   |             |
| the event that a borrower\'s loan |   |   |                |   |             |
| payments become delinquent or the |   |   |                |   |             |
| borrower defaults on its loan:    |   |   |                |   |             |
| (1) Report the borrower\'s        |   |   |                |   |             |
| delinquent account to a credit    |   |   |                |   |             |
| bureau; (2) Assess additional     |   |   |                |   |             |
| interest and penalty charges for  |   |   |                |   |             |
| the period of time that payment   |   |   |                |   |             |
| is not made; (3) Assess charges   |   |   |                |   |             |
| to cover additional               |   |   |                |   |             |
| administrative costs incurred by  |   |   |                |   |             |
| the Government to service the     |   |   |                |   |             |
| borrower\'s account; (4) Offset   |   |   |                |   |             |
| amounts owed to the borrower      |   |   |                |   |             |
| under other Federal programs; (5) |   |   |                |   |             |
| Refer the borrower\'s debt to the |   |   |                |   |             |
| Internal Revenue Service for      |   |   |                |   |             |
| offset against any amount owed to |   |   |                |   |             |
| the borrower as an income tax     |   |   |                |   |             |
| refund; (6) Refer the borrower\'s |   |   |                |   |             |
| account to a private collection   |   |   |                |   |             |
| agency to collect the amount due; |   |   |                |   |             |
| and (7) Refer the borrower\'s     |   |   |                |   |             |
| account to the Department of      |   |   |                |   |             |
| Justice for litigation in the     |   |   |                |   |             |
| courts. All of these actions can  |   |   |                |   |             |
| and will be used to recover any   |   |   |                |   |             |
| debts owed when it is determined  |   |   |                |   |             |
| to be in the interest of the      |   |   |                |   |             |
| Government to do so.              |   |   |                |   |             |
+-----------------------------------+---+---+----------------+---+-------------+
| **CERTIFICATION**                 |   |   |                |   |             |
|                                   |   |   |                |   |             |
| The undersigned certifies that    |   |   |                |   |             |
| the information contained herein  |   |   |                |   |             |
| is accurate and complete to the   |   |   |                |   |             |
| best of his knowledge and belief. |   |   |                |   |             |
+-----------------------------------+---+---+----------------+---+-------------+
| **SIGNATURE OF AUTHORIZED         |   | * |                |   | **DATE**    |
| OFFICIAL**                        |   | * |                |   |             |
|                                   |   | T |                |   |             |
|                                   |   | I |                |   |             |
|                                   |   | T |                |   |             |
|                                   |   | L |                |   |             |
|                                   |   | E |                |   |             |
|                                   |   | * |                |   |             |
|                                   |   | * |                |   |             |
+-----------------------------------+---+---+----------------+---+-------------+
| Page 3 of 3 RUS FORM 532          |   |   |                |   |             |
+-----------------------------------+---+---+----------------+---+-------------+

**[Schedule A]{.smallcaps}**

**[CONGRESSIONAL DISTRICTS]{.smallcaps}**

**[APPLICANT'S CONGRESSIONAL DISTRICT:]{.smallcaps}**

**[CONGRESSIONAL DISTRICTS COVERED BY THE PROJECT:]{.smallcaps}**

**[Schedule B-1]{.smallcaps}**

**[Sample Legal Opinion]{.smallcaps}**

Date

Administrator

Rural Development, Utilities Programs

United States Department of Agriculture

Stop 1500

Washington, D.C. 20250-1500

Subject: (Company Name)

Ladies and Gentlemen:

We are counsel to \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ (the "Company")
in connection with the Company's application (Application) for a loan
from the Rural Development, Utilities Programs (Rural Development), to
provide broadband service. We have examined or caused to be examined by
competent and trustworthy persons such corporate records and files and
such other records, indexes, and files as we have deemed necessary to
permit us to render the opinions expressed herein. We are of the opinion
that:

1\. The Company is a (corporation, cooperative, limited liability
company, etc.) duly formed, validly existing and in good standing under
the laws of the State of \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_.

2\. The Company operates in the States of
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ and is duly licensed and
qualified and in good standing as a foreign
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_, authorized to do business and own
property in such States.

3\. The Company has full legal right, power and authority to own its
property and carry on its business as now conducted.

4\. The execution, delivery and performance by the Company of the
Application and the consummation of the transactions contemplated
thereby are within the powers of the Company.

5\. The Application has been duly executed by the Company.

6\. The Company owns the real property described on Schedule B-2
attached hereto and has the power to grant a security interest in such
property and all other property owned by the Company to the Rural
Development as collateral for the loan described in the Application.

7\. The real property leases, tower leases and equipment leases (Leases)
identified in Schedules B-2 and S are in full force and effect and
constitute the legal, valid and binding obligations of the Company and
the other parties thereto. (Please list leases in appropriate categories
on Schedule B-2.)

8\. The Company has such rights under the Leases as are necessary to
operate its business as described in the Application and may pledge and
assign its interests in the Leases to Rural Development as security for
the loans described in the Application.

9\. The property descriptions set forth on Schedule B-2 are sufficient
for purposes of financing statements creating a lien on such collateral
under Article 9 of the Uniform Commercial Code in effect in the State of
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_, where the financing
statement must be filed.

10\. Schedule B-2 contains complete and accurate descriptions of all the
real property owned or leased by the Company, including easements and
rights-of-way, which are sufficient, in form and substance, for
inclusion in the granting clause of a mortgage creating a lien on such
property.

11\. A security interest in the Leases can be perfected by filing a
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ in the Office of
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ in the State of
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_.

12\. For purposes of Article 9 of the Uniform Commercial Code in the
State of \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_, the Company is a "transmitting
utility."

13\. The Company's organizational number is
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_.

14\. The exact true and correct legal name of the Company, as stated in
its organization documents, is
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_.

15\. The Company's corporate debt limit is
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_.

16\. The Company's estimated tax liability for filing a mortgage in the
appropriate counties for the proposed loan is estimated to be
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_.

17\. The execution, delivery and performance by the Company of the loan
documents would not (would) require the consent, permission or
authorization of (any) governmental authority.

18\. The Company's taxpayer identification number is
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_.

19\. The pending claims or litigation against the Company are described
in an attachment to this legal opinion. There are no pending claims or
litigation against the Company.

20\. The Company has the following subsidiaries or parent: (List and
describe all) \_\_\_\_\_\_\_\_\_\_\_\_\_\_.

21\. The titles of the Company officials with the proper authority to
execute all loan documents on behalf of the Company, and attest to the
execution where required, are
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_.

Very Truly Yours,

**[Schedule B-2]{.smallcaps}**

**[Real Property Schedule]{.smallcaps}**

1\. Real Property Owned:

2\. Real Property Leases that are part of the Telecommunications System
(indicate record owner of property):

3\. Easements and Rights-of-Way:

**[Schedule C-1]{.smallcaps}**

**[Equal Opportunity and Nondiscrimination Certification]{.smallcaps}**

**U.S. Department of Agriculture**

Rural Development, Utilities Programs

All loans made under the Rural Broadband Access Loan and Loan Guarantee
Program are subject to the nondiscrimination provisions of Title VI of
the Civil Rights Act of 1964, as amended, (7 C.F.R. Part 15); Section
504 of the Rehabilitation Act of 1973, as amended, (29 U.S.C. 901 *et
seq*; 7 C.F.R. Part 15b); and the Age Discrimination Act of 1975, as
amended (42 U.S.C. 6101 *et seq*.; 45 C.F.R. Part 90), and Executive
Order 11375, Amending Executive Order 11246, Relating to Equal
Employment Opportunity (3 C.F.R. 1966, 1970).

All recipients of financial assistance from Rural Development, the
prospective primary participant commits to carry out Rural Development's
established policy to comply with the requirements of the above laws and
executive orders to the effect that no person in the United States
shall, "on the basis of race, color, national origin, handicap, or age,
be excluded from participation in, be denied the benefits of, or be
otherwise subjected to discrimination under the Rural Broadband Access
Loan and Loan Guarantee Program.

We
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
(the Applicant) hereby certify that, as a prospective recipient under
the said Rural Broadband Access Loan and Loan Guarantee Program, we will
comply with the above referenced laws and executive orders.

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
*\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_*

(Date) (Authorized Representative's Signature)

*\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_*

Name:

*\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_*

Title:

*(This is not an official Government form. It has been prepared to
assist and expedite the application process and is only intended for use
in the Rural Broadband Access Loan and Loan Guarantee Program.)*

**[Schedule C-2]{.smallcaps}**

**[Certification Regarding Architectural Barriers]{.smallcaps}**

**U.S. Department of Agriculture**

Rural Development, Utilities Programs

All facilities financed with Rural Development loans that are open to
the public, or in which physically handicapped persons may be employed
or reside, must be designed, constructed, and/or altered to be readily
accessible to, and usable by, handicapped persons. Standards for these
facilities must comply with the Architectural Barriers Act of 1968, as
amended, 42 U.S.C. 4151 *et seq.*) and with the Uniform Federal
Accessibility Standards (UFAS), (Appendix A to 41 C.F.R. subpart
101-19.6).

As a prospective primary participant recipient of financial assistance
from Rural Development, this organization commits to carry out Rural
Development's established policy to comply with the requirements of the
above referenced law to the effect that all facilities must be readily
accessible to and usable by handicapped persons.

We,
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
(the Applicant) hereby certify that, as a prospective recipient under
the Rural Broadband Access Loan and Loan Guarantee Program, we are in
compliance, or will be in compliance upon completion of the project,
with the above referenced law.

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

(Date) (Authorized Representative's Signature)

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Name:

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Title:

*(This is not an official Government form. It has been prepared to
assist and expedite the application process and is only intended for use
in the Rural Broadband Access Loan and Loan Guarantee Program.)*

**[Schedule C-3]{.smallcaps}**

**[Certificate Regarding Flood Hazard Area Precautions]{.smallcaps}**

**U.S. Department of Agriculture**

Rural Development, Utilities Programs

Please check the appropriate line below:

\(a\) The project is not located in a 100 year flood plain; therefore,
no Flood Insurance is required.

\(b\) The project is located in a 100 year flood plain and the required
insurance is or will be provided by:

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

We,
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
(the Applicant) hereby certify that, as a prospective recipient under
the Rural Broadband Access Loan and Loan Guarantee Program, we are in
compliance, or will be in compliance during construction and/or
installation of equipment and upon completion of the project, with the
above referenced law.

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

(Date) (Authorized Representative's Signature)

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Name:

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Title:

*(This is not an official Government form. It has been prepared to
assist and expedite the application process and is only intended for use
in the Rural Broadband Access Loan and Loan Guarantee Program.)*

**[Schedule C-4]{.smallcaps}**

**[Uniform Relocation Assistance and Real Property
Acquisition]{.smallcaps}**

**[Policies Act of 1970 Certification]{.smallcaps}**

**U.S. Department of Agriculture**

Rural Development, Utilities Programs

We, \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
(the Applicant) assure the U.S. government that we will comply with the
Uniform Relocation Assistance and Real Property Acquisition Policies Act
of 1970, as amended, 42 U.S.C. 4601 *et seq*., and with implementing
federal regulations in 49 C.F.R. Part 24 and 7 C.F.R. Part 21.

Specifically, we assures that whenever Federal financial assistance is
used to pay for any part of the cost of a program or project which will
result in the displacement of any person:

> \(a\) Fair and reasonable relocation payments and assistance shall be
> provided to or for displaced persons in accordance with sections 202,
> 203, and 204 of the Uniform Act;
>
> \(b\) Relocation assistance programs offering the services described
> in section 205 of the Uniform Act shall be provided to displaced
> persons; and
>
> \(c\) Within a reasonable period of time prior to displacement,
> comparable replacement dwellings will be available to displaced
> persons in accordance with section 205(c) (3) of the Uniform Act.

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

(Date) (Authorized Representative's Signature)

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Name:

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Title:

*(This is not an official Government form. It has been prepared to
assist and expedite the application process and is only intended for use
in the Rural Broadband Access Loan and Loan Guarantee Program.)*

**[Schedule C-5]{.smallcaps}**

**[Certification Regarding Debarment, Suspension, and Other
Responsibility Matters -- Primary Covered Transactions]{.smallcaps}**

**U.S. Department of Agriculture**

Rural Development, Utilities Programs

This certification is required by the regulations implementing Executive
Order 12549, *Debarment and Suspension*, 7 C.F.R. § 3017.510,
*Participants' Responsibilities*.

\(1\) We, \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
(the Applicant) (hereinafter the "Company") hereby certify to the best
of our knowledge and belief that neither the Company, nor any of its
principals:

> \(a\) are presently debarred, suspended, proposed for Debarment,
> declared ineligible, or voluntarily excluded from covered transactions
> by any Federal department or agency;
>
> \(b\) have within a 3-year period preceding this proposal been
> convicted of or had a civil judgment rendered against them for
> commission of fraud or a criminal offense in connection with
> obtaining, attempting to obtain, or performing a public (Federal,
> State, or local) transaction or contract under a public transaction;
> violation of Federal or State antitrust statutes or commission of
> embezzlement, theft, forgery, bribery, falsification or destruction of
> records, making false statements, or receiving stolen property;
>
> \(c\) are presently indicted for or otherwise criminally or civilly
> charged by a governmental entity (Federal, State, or local) with
> commission of any of the offenses enumerated in paragraph (1)(b) of
> this certification; and
>
> \(d\) have within a 3-year period preceding this Application had one
> or more public transactions (Federal, State, or local) terminated for
> cause or default.

\(2\) If we are unable to certify to any of the statements in this
certification, we shall attach an explanation hereto.

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

(Date) (Authorized Representative's Signature)

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Name:

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Title:

*(This is not an official Government form. It has been prepared to
assist and expedite the application process and is only intended for use
in the Rural Broadband Access Loan and Loan Guarantee Program.)*

**[Schedule C-6]{.smallcaps}**

**[Certification Regarding Lobbying for Contracts,
Grants,]{.smallcaps}**

**[Loans, and Cooperative Agreements]{.smallcaps}**

**U.S. Department of Agriculture**

Rural Development, Utilities Programs

We, \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
(the Applicant) the undersigned certify, to the best of our knowledge
and belief, that:

\(1\) No Federal appropriated funds have been paid or will be paid, by
or on our behalf, to any person for influencing or attempting to
influence an officer or employee of any agency, a Member of Congress, an
officer or employee of Congress, or an employee of a Member of Congress
in connection with the awarding of any Federal contract, the making of
any Federal grant or loan, the entering into of any cooperative
agreement, and the extension, continuation, renewal, amendment, or
modification of any Federal contract, grant, loan, or cooperative
agreement.

\(2\) If any funds other than Federal appropriated funds have been paid
or will be paid to any person for influencing or attempting to influence
an officer or employee of any agency, a Member of Congress, an officer
or employee of Congress, or an employee of a Member of Congress in
connection with this Federal contract, grant, loan, or cooperative
agreement, we shall complete and submit Standard Form-LLL, Disclosure
Form to Report Lobbying, in accordance with its instructions.

See <http://www.whitehouse.gov/omb/grants/sflllin.pdf> for Disclosure
Instructions.

\(3\) We shall require that the language of this certification be
included in the award documents for all subawards at all tiers
(including subcontracts, subgrants, and contracts under grants, loans,
and cooperative agreements) and that all subrecipients shall certify and
disclose accordingly.

> This certification is a material representation of fact upon which
> reliance was placed when this transaction was made or entered into.
> Submission of this certification is a prerequisite for making or
> entering into this transaction imposed by 31 U.S.C. § 1352. Any person
> who fails to file the required certification shall be subject to a
> civil penalty of not less than \$10,000 and not more than \$100,000
> for each such failure.

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

(Date) (Authorized Representative's Signature)

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Name:

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Title:

*(This is not an official Government form. It has been prepared to
assist and expedite the application process and is only intended for use
in the Rural Broadband Access Loan and Loan Guarantee Program.)*

**SCHEDULE C-7**

**[Environmental Impact Certification]{.smallcaps}**

Environmental Project Summary:

*(This description should encompass all construction in the project, no
matter the source of funding. It should provide details of how the
project will affect the environment (wetlands, farmlands, floodplain,
cultural environment, endangered species, environmental quality, and
historic preservation). If additional space is needed, continue on white
bond paper and attach to this certification.)*

**CERTIFICATION**

**I hereby certify that the construction proposed in this application
will not adversely impact the environment or historic preservation.**

**\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_**

**(Signature and Date)**

**\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_**

**(Print or Type Title)**

*(This is not an official Government form. It has been prepared to
assist and expedite the application process and is only intended for use
in the Rural Broadband Access Loan and Loan Guarantee Program.)*

**[Schedule C-8]{.smallcaps}**

**[System Design Certification]{.smallcaps}**

We the undersigned, certify that the data in Schedules O, P and Q in
this application that describe the Systems Design, is correct to the
best of our knowledge, and believe it reasonably reflects the cost to
serve the proposed subscribers with broadband service.

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

(Date) (Authorized Representative's Signature)

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Name:

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Title:

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

(Date) (Signature of System Design Firm's Principal)

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Name:

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Title:

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

(Date) (Certifying Engineer's Signature)

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Name:

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Title:

*(This is not an official Government form. It has been prepared to
assist and expedite the application process and is only intended for use
in the Rural Broadband Access Loan and Loan Guarantee Program.)*

**[Schedule D-1]{.smallcaps}**

**[EXISTING AND PROPOSED COMMUNITIES]{.smallcaps}**

+---+-------------------+-----------+----+--------+------+-----+-----+
|   | **Community (E)   | *         | *  | **Com  | **   | *   | *   |
|   | or (P)**          | *County** | *S | munity | HH** | *HH | *Bu |
|   |                   |           | ta | Popula |      | Ru  | s** |
|   |                   |           | te | tion** | **   | ral |     |
|   |                   |           | ** |        | Town | Are |     |
|   |                   |           |    |        | Ar   | a** |     |
|   |                   |           |    |        | ea** |     |     |
+---+-------------------+-----------+----+--------+------+-----+-----+
| * |                   |           |    |        |      |     |     |
| * |                   |           |    |        |      |     |     |
| 1 |                   |           |    |        |      |     |     |
| * |                   |           |    |        |      |     |     |
| * |                   |           |    |        |      |     |     |
+---+-------------------+-----------+----+--------+------+-----+-----+
| * |                   |           |    |        |      |     |     |
| * |                   |           |    |        |      |     |     |
| 2 |                   |           |    |        |      |     |     |
| * |                   |           |    |        |      |     |     |
| * |                   |           |    |        |      |     |     |
+---+-------------------+-----------+----+--------+------+-----+-----+
| * |                   |           |    |        |      |     |     |
| * |                   |           |    |        |      |     |     |
| 3 |                   |           |    |        |      |     |     |
| * |                   |           |    |        |      |     |     |
| * |                   |           |    |        |      |     |     |
+---+-------------------+-----------+----+--------+------+-----+-----+
| * |                   |           |    |        |      |     |     |
| * |                   |           |    |        |      |     |     |
| 4 |                   |           |    |        |      |     |     |
| * |                   |           |    |        |      |     |     |
| * |                   |           |    |        |      |     |     |
+---+-------------------+-----------+----+--------+------+-----+-----+
| * |                   |           |    |        |      |     |     |
| * |                   |           |    |        |      |     |     |
| 5 |                   |           |    |        |      |     |     |
| * |                   |           |    |        |      |     |     |
| * |                   |           |    |        |      |     |     |
+---+-------------------+-----------+----+--------+------+-----+-----+
| * |                   |           |    |        |      |     |     |
| * |                   |           |    |        |      |     |     |
| 6 |                   |           |    |        |      |     |     |
| * |                   |           |    |        |      |     |     |
| * |                   |           |    |        |      |     |     |
+---+-------------------+-----------+----+--------+------+-----+-----+
| * |                   |           |    |        |      |     |     |
| * |                   |           |    |        |      |     |     |
| 7 |                   |           |    |        |      |     |     |
| * |                   |           |    |        |      |     |     |
| * |                   |           |    |        |      |     |     |
+---+-------------------+-----------+----+--------+------+-----+-----+
| * |                   |           |    |        |      |     |     |
| * |                   |           |    |        |      |     |     |
| 8 |                   |           |    |        |      |     |     |
| * |                   |           |    |        |      |     |     |
| * |                   |           |    |        |      |     |     |
+---+-------------------+-----------+----+--------+------+-----+-----+
| * |                   |           |    |        |      |     |     |
| * |                   |           |    |        |      |     |     |
| 9 |                   |           |    |        |      |     |     |
| * |                   |           |    |        |      |     |     |
| * |                   |           |    |        |      |     |     |
+---+-------------------+-----------+----+--------+------+-----+-----+
| * |                   |           |    |        |      |     |     |
| * |                   |           |    |        |      |     |     |
| 1 |                   |           |    |        |      |     |     |
| 0 |                   |           |    |        |      |     |     |
| * |                   |           |    |        |      |     |     |
| * |                   |           |    |        |      |     |     |
+---+-------------------+-----------+----+--------+------+-----+-----+
| * |                   |           |    |        |      |     |     |
| * |                   |           |    |        |      |     |     |
| 1 |                   |           |    |        |      |     |     |
| 1 |                   |           |    |        |      |     |     |
| * |                   |           |    |        |      |     |     |
| * |                   |           |    |        |      |     |     |
+---+-------------------+-----------+----+--------+------+-----+-----+
| * |                   |           |    |        |      |     |     |
| * |                   |           |    |        |      |     |     |
| 1 |                   |           |    |        |      |     |     |
| 2 |                   |           |    |        |      |     |     |
| * |                   |           |    |        |      |     |     |
| * |                   |           |    |        |      |     |     |
+---+-------------------+-----------+----+--------+------+-----+-----+
| * |                   |           |    |        |      |     |     |
| * |                   |           |    |        |      |     |     |
| 1 |                   |           |    |        |      |     |     |
| 3 |                   |           |    |        |      |     |     |
| * |                   |           |    |        |      |     |     |
| * |                   |           |    |        |      |     |     |
+---+-------------------+-----------+----+--------+------+-----+-----+
| * |                   |           |    |        |      |     |     |
| * |                   |           |    |        |      |     |     |
| 1 |                   |           |    |        |      |     |     |
| 4 |                   |           |    |        |      |     |     |
| * |                   |           |    |        |      |     |     |
| * |                   |           |    |        |      |     |     |
+---+-------------------+-----------+----+--------+------+-----+-----+
| * |                   |           |    |        |      |     |     |
| * |                   |           |    |        |      |     |     |
| 1 |                   |           |    |        |      |     |     |
| 5 |                   |           |    |        |      |     |     |
| * |                   |           |    |        |      |     |     |
| * |                   |           |    |        |      |     |     |
+---+-------------------+-----------+----+--------+------+-----+-----+
| * |                   |           |    |        |      |     |     |
| * |                   |           |    |        |      |     |     |
| 1 |                   |           |    |        |      |     |     |
| 6 |                   |           |    |        |      |     |     |
| * |                   |           |    |        |      |     |     |
| * |                   |           |    |        |      |     |     |
+---+-------------------+-----------+----+--------+------+-----+-----+
| * |                   |           |    |        |      |     |     |
| * |                   |           |    |        |      |     |     |
| 1 |                   |           |    |        |      |     |     |
| 7 |                   |           |    |        |      |     |     |
| * |                   |           |    |        |      |     |     |
| * |                   |           |    |        |      |     |     |
+---+-------------------+-----------+----+--------+------+-----+-----+
| * |                   |           |    |        |      |     |     |
| * |                   |           |    |        |      |     |     |
| 1 |                   |           |    |        |      |     |     |
| 8 |                   |           |    |        |      |     |     |
| * |                   |           |    |        |      |     |     |
| * |                   |           |    |        |      |     |     |
+---+-------------------+-----------+----+--------+------+-----+-----+
| * |                   |           |    |        |      |     |     |
| * |                   |           |    |        |      |     |     |
| 1 |                   |           |    |        |      |     |     |
| 9 |                   |           |    |        |      |     |     |
| * |                   |           |    |        |      |     |     |
| * |                   |           |    |        |      |     |     |
+---+-------------------+-----------+----+--------+------+-----+-----+
| * |                   |           |    |        |      |     |     |
| * |                   |           |    |        |      |     |     |
| 2 |                   |           |    |        |      |     |     |
| 0 |                   |           |    |        |      |     |     |
| * |                   |           |    |        |      |     |     |
| * |                   |           |    |        |      |     |     |
+---+-------------------+-----------+----+--------+------+-----+-----+
|   | **TOTALS**        |           |    |        |      |     |     |
+---+-------------------+-----------+----+--------+------+-----+-----+

**(E) = Existing (P) = Proposed HH = Households**

**Note 1: List shall include all communities that the applicant is
currently serving and those proposed to be served over the 5-year loan
forecast period.**

**Note 2: Additional communities can be listed on supplemental
worksheets**

**[Schedule D-2]{.smallcaps}**

**[EXISTING SERVICE PROVIDERS]{.smallcaps}**

  ---- ----------------- -------------------- -------------- ---------------
       **Community**     **Name Of Service    **Services     **Rates**
                         Provider**           Provided**     

  1                                                           

  2                                                           

  3                                                          

  4                                                           

  5                                                           

  6                                                           

  7                                                           

  8                                                           

  9                                                           

  10                                                          

  11                                                          

  12                                                          

  13                                                          

  14                                                          

  15                                                          

  16                                                          

  17                                                          

  18                                                          

  19                                                          

  20                                                          
  ---- ----------------- -------------------- -------------- ---------------

**Note: Additional communities shall be listed on supplemental
worksheets**

**[Schedule D-3]{.smallcaps}**

**[Service Area Maps]{.smallcaps}**

**[Schedule E]{.smallcaps}**

**[Certification Regarding The Availability Of]{.smallcaps}**

**[Broadband Service In Eligible Rural Communities]{.smallcaps}**

Please check the appropriate line below:

\(a\) Broadband service IS NOT available to residential customers within
our proposed service area.

\(b\) Broadband service IS available to residential customers within our
proposed service area.

We,
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
(Applicant) hereby certify that the information above is correct, to the
best of our knowledge and belief, and reasonably reflects the extent to
which broadband service is available within our proposed service area.

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Date (Authorized Representative's Signature)

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Name:

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Title:

*(This is not an official Government form. It has been prepared to
assist and expedite the application process and is only intended for use
in the Rural Broadband Access Loan and Loan Guarantee Program.)*

**[Schedule F-1]{.smallcaps}**

**[Proof Of Legal Notice]{.smallcaps}**

**[Schedule F-2]{.smallcaps}**

**[Sufficiency of Legal Notice]{.smallcaps}**

**[Schedule G-1]{.smallcaps}**

**[Articles of Incorporation or Organization]{.smallcaps}**

**[Schedule G-2]{.smallcaps}**

**[Copy of the State LLC Statute (If Applicable)]{.smallcaps}**

**[Schedule G-3]{.smallcaps}**

**[Board of Directors or Managing Members of the LLC]{.smallcaps}**

**[Schedule G-4]{.smallcaps}**

**[Organizational Chart and Statement of Experience]{.smallcaps}**

**[Schedule G-5]{.smallcaps}**

**[Parent and Subsidiaries]{.smallcaps}**

**[Schedule H]{.smallcaps}**

**[Executive Summary]{.smallcaps}**

**[Schedule I]{.smallcaps}**

**[Credit Support Requirement]{.smallcaps}**

1\. Credit Support will be met by the following: (check the applicable
box and insert the value for each)

a\. Cash \_\_\_\_\_\_\_\_

b\. Net Tangible Assets \_\_\_\_\_\_\_\_

c\. Licenses \_\_\_\_\_\_\_\_

d\. Letter of Credit \_\_\_\_\_\_\_\_

2\. Has the applicant had a positive Cash Flow as an operating
telecommunication company for the previous two calendar years preceding
the submission date of this application? (Cash Flow is defined as Cash
Provided (Used) By Operating Activities shown in the "Statement of Cash
Flows" as required under Generally Accepted Accounting Principles. Cash
Flow should be calculated using the "Statement of Cash Flows" included
in the Schedule N-3c described as line item "Net Cash Provided (Used) By
Operating Activities.")

> Yes

No

Provide Cash Flow for the past calendar year \$\_\_\_\_\_\_\_\_\_\_\_\_.

Provide Cash Flow for the second previous calendar year
\$\_\_\_\_\_\_\_\_\_\_\_.

**[Schedule J]{.smallcaps}**

**[Board Resolution]{.smallcaps}**

**[Schedule K-1]{.smallcaps}**

**[Research Data]{.smallcaps}**

**[SCHEDULE K-2]{.smallcaps}**

**[Market Analysis]{.smallcaps}**

**[Schedule L]{.smallcaps}**

**[Business Plan]{.smallcaps}**

**[Schedule M]{.smallcaps}**

**[Management and Compensation]{.smallcaps}**

**[Schedule N-1]{.smallcaps}**

**[Historical Financial Statements]{.smallcaps}**

**[With Full Footnotes & Disclosures]{.smallcaps}**

**[Three Preceding Years]{.smallcaps}**

**[Fiscal Years \_\_\_\_\_\_\_\_\_\_]{.smallcaps}**

  ------------ --------------- -------- -------- -------- -------- -------- -------- -------- -------- -------- -------- -------- -------- -------- -- -------- -- --------
                                                                                                                                                                   

                                                                                                                                                                   

               **Community**   **Year                     **Year                     **Year                     **Year                     **Year                  
                               1**                        2**                        3**                        4**                        5**                     

  ** **        ** **           **Plan   **Plan   **Plan   **Plan   **Plan   **Plan   **Plan   **Plan   **Plan   **Plan   **Plan   **Plan   **Plan      **Plan      **Plan
                               1**      2**      3**      1**      2**      3**      1**      2**      3**      1**      2**      3**      1**         2**         3**

  1                                                                                                                                                                 

  2                                                                                                                                                                 

  3                                                                                                                                                                 

  4                                                                                                                                                                 

  5                                                                                                                                                                 

  6                                                                                                                                                                 

  7                                                                                                                                                                 

  8                                                                                                                                                                 

  9                                                                                                                                                                 

  10                                                                                                                                                                

  TOTAL                                                                                                                                                             

                                                                                                                                                                   

               Bandwidth                                                                                                                                           
               Levels & Rates                                                                                                                                      

  Plan 1                                                                                                                                                           

  Plan 2                                                                                                                                                           

  Plan 3                                                                                                                                                           

                                                                                                                                                                   

  Note: Column                                                                                                                                                     
  headings                                                                                                                                                         
  should be                                                                                                                                                        
  changed to                                                                                                                                                       
  reflect the                                                                                                                                                      
  name of the                                                                                                                                                      
  plan to be                                                                                                                                                       
  offered.                                                                                                                                                         
  Additional                                                                                                                                                       
  columns may                                                                                                                                                      
  be added for                                                                                                                                                     
  each year if                                                                                                                                                     
  more than                                                                                                                                                        
  three plans                                                                                                                                                      
  are offered.                                                                                                                                                     
  ------------ --------------- -------- -------- -------- -------- -------- -------- -------- -------- -------- -------- -------- -------- -------- -- -------- -- --------

**[Schedule N-2a]{.smallcaps}**

**[Subscriber Projection Table]{.smallcaps}**

**[Data Services]{.smallcaps}**

**[Schedule N-2b]{.smallcaps}**

**[Subscriber Projection Table]{.smallcaps}**

**[Voice Services]{.smallcaps}**

  ------------- --------------- --------- --------- ----------- --------- --------- ----------- --------- --------- ----------- --------- --------- ----------- --------- --------- -----------
                                                                                                                                                                                    

                **Community**   **Year                          **Year                          **Year                          **Year                          **Year              
                                1**                             2**                             3**                             4**                             5**                 

  ** **         ** **           **Res**   **Bus**   **Other**   **Res**   **Bus**   **Other**   **Res**   **Bus**   **Other**   **Res**   **Bus**   **Other**   **Res**   **Bus**   **Other**

  1                                                                                                                                                                                  

  2                                                                                                                                                                                  

  3                                                                                                                                                                                  

  4                                                                                                                                                                                  

  5                                                                                                                                                                                  

  6                                                                                                                                                                                  

  7                                                                                                                                                                                  

  8                                                                                                                                                                                  

  9                                                                                                                                                                                  

  10                                                                                                                                                                                 

  TOTAL                                                                                                                                                                              

                                                                                                                                                                                    

  Rates:                                                                                                                                                                            

  Residential                                                                                                                                                                       
  Service                                                                                                                                                                           

  Business                                                                                                                                                                          
  Service                                                                                                                                                                           

  Other                                                                                                                                                                             
  (Specify):                                                                                                                                                                        
  ------------- --------------- --------- --------- ----------- --------- --------- ----------- --------- --------- ----------- --------- --------- ----------- --------- --------- -----------

**[Schedule N-2c]{.smallcaps}**

**[Subscriber Projection Table]{.smallcaps}**

**[Video Services]{.smallcaps}**

  ------------ --------------- -------- ------- ----------- ---------- ------- ----------- -------- ------- ----------- -------- ------- ----------- -------- ------- -----------
                                                                                                                                                                      

               **Community**   **Year                       **Year 2**                     **Year                       **Year                       **Year           
                               1**                                                         3**                          4**                          5**              

  ** **        ** **           **Pkg    **Pkg   **Other**   **Pkg1**   **Pkg   **Other**   **Pkg    **Pkg   **Other**   **Pkg    **Pkg   **Other**   **Pkg    **Pkg   **Other**
                               1**      2**                            2**                 1**      2**                 1**      2**                 1**      2**     

  1                                                                                                                                                                    

  2                                                                                                                                                                    

  3                                                                                                                                                                    

  4                                                                                                                                                                    

  5                                                                                                                                                                    

  6                                                                                                                                                                    

  7                                                                                                                                                                    

  8                                                                                                                                                                    

  9                                                                                                                                                                    

  10                                                                                                                                                                   

  TOTAL                                                                                                                                                                

                                                                                                                                                                      

  Rates:                                                                                                                                                              

  Package 1:                                                                                                                                                          

  Package 2:                                                                                                                                                          

  Other                                                                                                                                                               
  (Specify):                                                                                                                                                          

                                                                                                                                                                      

  Note: Column                                                                                                                                                        
  headings                                                                                                                                                            
  should be                                                                                                                                                           
  changed to                                                                                                                                                          
  reflect the                                                                                                                                                         
  name of the                                                                                                                                                         
  service                                                                                                                                                             
  package to                                                                                                                                                          
  be offered.                                                                                                                                                         
  Additional                                                                                                                                                          
  columns may                                                                                                                                                         
  be added for                                                                                                                                                        
  each year if                                                                                                                                                        
  more than                                                                                                                                                           
  three                                                                                                                                                               
  packages are                                                                                                                                                        
  offered.                                                                                                                                                            
  ------------ --------------- -------- ------- ----------- ---------- ------- ----------- -------- ------- ----------- -------- ------- ----------- -------- ------- -----------

**[Schedule N-3a]{.smallcaps}**

**[Balance Sheet]{.smallcaps}**

**[Pro Forma Five-Year Financial Forecast]{.smallcaps}**

  --------------------------- ------------ ------ ------ --------- ------------ ------ ------ ------ ------
                                                                                                     

                              HISTORICAL                           FORECASTED                        

                              Year End     Year   Year                                               
                                           End    End                                                

                              1            2      3      Current   Year 1       Year 2 Year 3 Year 4 Year 5

                                                                                                     

  **ASSETS**                                                                                         

  CURRENT                                                                                            

  Cash and Cash Equivalents                                                                          

  Accounts Receivable                                                                                

  Materials and Supplies                                                                             

  Other Current                                                                                      

  Total Current Assets                                                                               

                                                                                                     

  LONG TERM                                                                                          

  Property, Plant and                                                                                
  Equipment                                                                                          

  Licenses & Intangibles                                                                             

  Accumulated Depreciation                                                                           

  Accumulated Amortization                                                                           

  Deferred Charges                                                                                    

  Prepaids/Accruals                                                                                  

  Other Assets                                                                                       

  Total Long Term Assets                                                                              

  **TOTAL ASSETS**                                                                                   
  --------------------------- ------------ ------ ------ --------- ------------ ------ ------ ------ ------

**[Schedule N-3a (continued)]{.smallcaps}**

**[Balance Sheet]{.smallcaps}**

  --------------------------- ---- ---- ---- ---- ---- ---- ---- ---- ----
                                                                      

  **LIABILITIES**                                                     

  CURRENT                                                             

  Accounts Payable                                                    

  Notes Payable-Short Term                                            

  Current Portion of Long                                             
  Term Debt                                                           

  Other Current                                                        

  Total Current Liabilities                                           

                                                                      

  LONG TERM                                                           

  Long Term Debt -- Current                                           

  New Proposed Long Term Debt                                         
  (Rural Development)                                                 

  Capital Lease                                                       

  Other Long Term                                                     

  Total Long Term Liabilities                                         

                                                                      

  **TOTAL LIABILITIES**                                               

                                                                      

  **CAPITAL & EQUITY**                                                

  Common Stock                                                        

  Preferred Stock                                                     

  Paid-in-Capital                                                     

  Retained Earnings                                                    

                                                                      

  **TOTAL CAPITAL & EQUITY**                                          

                                                                      

  **TOTAL LIABILITIES,                                                 
  CAPITAL & EQUITY**                                                  

                                                                      
  --------------------------- ---- ---- ---- ---- ---- ---- ---- ---- ----

**[Schedule N-3b]{.smallcaps}**

**[Income Statement]{.smallcaps}**

**[Pro Forma Five-Year Financial Forecast]{.smallcaps}**

  --------------------------- ------------ ------ ------ --------- ------------ ------ ------ ------ ------
                                                                                                     

                              HISTORICAL                           FORECASTED                        

                              Year End     Year   Year                                               
                                           End    End                                                

                              1            2      3      Current   Year 1       Year 2 Year 3 Year 4 Year 5

                                                                                                     

  **OPERATING REVENUES**                                                                             

  Local Network Service                                                                              

  Network Access Services                                                                            

  CATV Revenue                                                                                       

  Data Revenues                                                                                      

  Miscellaneous                                                                                      

  Uncollectibles                                                                                     

  Total Operating Revenues                                                                           

                                                                                                     

  **OPERATING EXPENSES**                                                                             

  Plant Specific Operations                                                                          

  Plant Non-Specific                                                                                 
  Operations                                                                                         

  Customer Operations                                                                                

  Corporate Operations                                                                               

  Cost of Goods Sold                                                                                 

  Depreciation                                                                                       

  Amortization                                                                                       

  State and Local Tax                                                                                

  Federal Income Tax                                                                                 

  Other Taxes                                                                                        

  Interest Expense                                                                                   

  Total Operating Expense                                                                            

                                                                                                     

  Other Income                                                                                       

  Interest and Dividend                                                                              
  Income                                                                                             

  Other Expenses                                                                                     

                                                                                                     

  **Net Income**                                                                                     

                                                                                                     
  --------------------------- ------------ ------ ------ --------- ------------ ------ ------ ------ ------

**[Schedule N-3c]{.smallcaps}**

**[Statement of Cash Flows]{.smallcaps}**

**[Pro Forma Five-Year Financial Forecast]{.smallcaps}**

  --------------------------- ------------ ----------- ----------- ----------- ------------ ------ ------ ------ ------
                              HISTORICAL                                       FORECASTED                        

                              Year End     Year End    Year End                                                  

                              1            2           3           Current     Year 1       Year 2 Year 3 Year 4 Year 5

  **CASH FLOWS FROM OPERATING                                                                                    
  ACTIVITIES**:                                                                                                  

  Net Income (Loss) After                                                                                        
  Income Taxes                                                                                                   

  Cash Flows from existing                                                                                       
  operating activities                                                                                           

  Adjustments To Reconcile                                                                                       
  Net Income To                                                                                                  

  Net Cash Provided By                                                                                           
  Operating Activities:                                                                                          

  Depreciation/Amortization                                                                                      

  Changes in Operating Assets                                                                                    
  and Liabilities:                                                                                               

  (Increase) Decrease in                                                                                         
  Accounts Receivable                                                                                            

  (Increase) Decrease in                                                                                         
  Deferred Charges - Other                                                                                       

  Increase (Decrease) in                                                                                          
  Accounts Payable                                                                                               

  **Net Cash Provided (Used)               []{.mark}   []{.mark}   []{.mark}                                     
  By Operating                                                                                                   
  Activities-Cash Flow**                                                                                         

                                                                                                                 

  **CASH FLOWS FROM INVESTING                                                                                    
  ACTIVITIES:**                                                                                                  

  Cash flows from existing                                                                                       
  investing activities                                                                                           

  Purchase of Plant                                                                                               

  Net Cash Used by Investing                                                                                     
  Activities:                                                                                                    

                                                                                                                 

  **CASH FLOWS FROM FINANCING                                                                                    
  ACTIVITIES:**                                                                                                  

  Cash flows from existing                                                                                       
  financing activities                                                                                           

  Proceeds From Equipment                                                                                        
  Financing Debt                                                                                                 

  Proceeds From Subordinated                                                                                     
  Debentures                                                                                                     

  Proceeds From Operations                                                                                       
  Financing Debt                                                                                                 

  Proceeds From Capital                                                                                          
  Contributions                                                                                                  

  Payment Of Equipment                                                                                           
  Financing Debt Principal                                                                                       

  Payment Of Subordinated                                                                                        
  Debentures                                                                                                     

  Payment Of Operations                                                                                          
  Financing Debt Principal                                                                                       

  Payment Of Capital                                                                                              
  Distributions                                                                                                  

  Net Cash Provided (Used) By                                                                                     
  Financing Activities:                                                                                          

                                                                                                                 

  **NET INCREASE (DECREASE)                                                                                      
  IN CASH**                                                                                                      

                                                                                                                 

  **CASH - Beginning Of                                                                                           
  Year**                                                                                                         

  **CASH - End Of Year**                                                                                          
  --------------------------- ------------ ----------- ----------- ----------- ------------ ------ ------ ------ ------

**[Schedule N-3d]{.smallcaps}**

**[Detail Narrative Of Financial Projection Assumptions]{.smallcaps}**

**[At a minimum include a description of the following:]{.smallcaps}**

***[Revenue:]{.smallcaps}***

-   **[Market Penetration Percentage Rates by service type -- Include
    assumptions concerning promotional offerings]{.smallcaps}**

-   **[Connect Pricing from your Business Plan and Market Study to
    Projections]{.smallcaps}**

-   **[Customer Attrition Rates]{.smallcaps}**

    ***[Expense:]{.smallcaps}***

-   **[Direct Cost of Sales -- (Cost of Goods Sold)]{.smallcaps}**

-   **[Operating Cost by service type]{.smallcaps}**

-   **[Fixed]{.smallcaps}**

-   **[Variable (& Escalation )]{.smallcaps}**

-   **[Maintenance Costs]{.smallcaps}**

-   **[Estimate Useful Life of Asset Classes]{.smallcaps}**

-   **[Income Tax Calculation Details and Other Applicable
    Taxes]{.smallcaps}**

-   **[Allowance for Doubtful Accounts Estimates]{.smallcaps}**

-   **[Other Income & Expense]{.smallcaps}**

-   **[General & Administrative Cost]{.smallcaps}**

-   **[Sales & Marketing Costs (Including historical customer
    acquisition costs )]{.smallcaps}**

-   **[On and Off Balance Sheet considerations]{.smallcaps}**

-   **[Capital Contributions and Distributions]{.smallcaps}**

    **[Schedule N-4]{.smallcaps}**

    **[Depreciation Schedule]{.smallcaps}**

    **[Schedule N-5]{.smallcaps}**

    **[Total Outstanding Indebtedness]{.smallcaps}**

**[Including Interest Expense, Key Terms and Conditions]{.smallcaps}**

**[Rural Development Liabilities]{.smallcaps}**

**[Non-Rural Development Long Term Liabilities]{.smallcaps}**

**[Schedule O]{.smallcaps}**

**[System Design]{.smallcaps}**

**[Schedule P]{.smallcaps}**

**[Network Diagrams]{.smallcaps}**

**[Schedule Q-1]{.smallcaps}**

**[SUMMARY OF PROJECT COSTS]{.smallcaps}**

  ----------------------------- --------------------- -------------------
  **Budget Category**           **Total Project       
                                Costs**               

                                **Rural Development   **Non-loan Funds**
                                Loan Funds**          

  NETWORK & ACCESS EQUIPMENT                           

  OUTSIDE PLANT                                        

  BUILDINGS                                            

  LAND                                                 

  TOWERS                                               

  CUSTOMER PREMISE EQUIPMENT                           

  OPERATING EQUIPMENT                                  

  ENGINEERING                                          

  REFINANCING                                          

  ACQUISITION                                          

  **TOTAL**                                            
  ----------------------------- --------------------- -------------------

**[Schedule Q-1a]{.smallcaps}**

**[SUMMARY OF PROJECT COSTS BY YEAR]{.smallcaps}**

+--------------------+------+------+------+------+------+------+------+
| **Budget           | **P  | **   | **   | **   | **   | **   | *    |
| Category**         | rior | Year | Year | Year | Year | Year | *Tot |
|                    | Yea  | 1**  | 2**  | 3**  | 4**  | 5**  | al** |
|                    | rs** |      |      |      |      |      |      |
|                    |      |      |      |      |      |      | *    |
|                    |      |      |      |      |      |      | *Pro |
|                    |      |      |      |      |      |      | ject |
|                    |      |      |      |      |      |      | Co   |
|                    |      |      |      |      |      |      | st** |
+--------------------+------+------+------+------+------+------+------+
| NETWORK & ACCESS   |      |      |      |      |      |      |      |
| EQUIPMENT          |      |      |      |      |      |      |      |
+--------------------+------+------+------+------+------+------+------+
| OUTSIDE PLANT      |      |      |      |      |      |      |      |
+--------------------+------+------+------+------+------+------+------+
| BUILDINGS          |      |      |      |      |      |      |      |
+--------------------+------+------+------+------+------+------+------+
| LAND               |      |      |      |      |      |      |      |
+--------------------+------+------+------+------+------+------+------+
| TOWERS             |      |      |      |      |      |      |      |
+--------------------+------+------+------+------+------+------+------+
| CUSTOMER PREMISE   |      |      |      |      |      |      |      |
| EQUIPMENT          |      |      |      |      |      |      |      |
+--------------------+------+------+------+------+------+------+------+
| OPERATING          |      |      |      |      |      |      |      |
| EQUIPMENT          |      |      |      |      |      |      |      |
+--------------------+------+------+------+------+------+------+------+
| ENGINEERING        |      |      |      |      |      |      |      |
+--------------------+------+------+------+------+------+------+------+
|                    |      |      |      |      |      |      |      |
+--------------------+------+------+------+------+------+------+------+
| **TOTAL**          |      |      |      |      |      |      |      |
+--------------------+------+------+------+------+------+------+------+

**[Schedule Q-2]{.smallcaps}**

**Breakdown of Network & Access Equipment Costs**

  -------------------- ----------------- -------------- ----------- ------------- ------------
  **Community/Site**   **Description**   **Quantity**   **Unit      **Extended    
                                                        Cost**      Cost**        

                                                                    **Rural       **Non-loan
                                                                    Development   Funds**
                                                                    Loan Funds**  

                                                                                  

                                                                                  

                                                                                  

                                                                                  

                                                                                  

                                                                                  

                                                                                  

                                                                                  

                                                                                  

                                                                                  

                                                                                  

                                                                                  

                                                                                  

                                                                                  

                                                                                  

                                                                                  

                                                                                  

                                                                                  

  **TOTAL**                                             []{.mark}   []{.mark}     
  -------------------- ----------------- -------------- ----------- ------------- ------------

**[Schedule Q-3]{.smallcaps}**

**Breakdown of OUTSIDE PLANT COSTS**

  -------------------- ----------------- -------------- ----------- ------------- ------------
  **Community/Site**   **Description**   **Quantity**   **Unit      **Extended    
                                                        Cost**      Cost**        

                                                                    **Rural       **Non-loan
                                                                    Development   Funds**
                                                                    Loan Funds**  

                                                                                  

                                                                                  

                                                                                  

                                                                                  

                                                                                  

                                                                                  

                                                                                  

                                                                                  

                                                                                  

                                                                                  

                                                                                  

                                                                                  

                                                                                  

                                                                                  

                                                                                  

                                                                                  

                                                                                  

                                                                                  

  **TOTAL**                                             []{.mark}   []{.mark}     
  -------------------- ----------------- -------------- ----------- ------------- ------------

**[Schedule Q-4]{.smallcaps}**

**Breakdown of BUILDINGS COSTS**

  -------------------- ----------------- -------------- ----------- ------------- ------------
  **Community/Site**   **Description**   **Quantity**   **Unit      **Extended    
                                                        Cost**      Cost**        

                                                                    **Rural       **Non-loan
                                                                    Development   Funds**
                                                                    Loan Funds**  

                                                                                  

                                                                                  

                                                                                  

                                                                                  

                                                                                  

                                                                                  

                                                                                  

                                                                                  

                                                                                  

                                                                                  

                                                                                  

                                                                                  

                                                                                  

                                                                                  

                                                                                  

                                                                                  

                                                                                  

                                                                                  

  **TOTAL**                                             []{.mark}   []{.mark}     
  -------------------- ----------------- -------------- ----------- ------------- ------------

**[Schedule Q-5]{.smallcaps}**

**Breakdown of LAND COSTS**

  -------------------- ----------------- -------------- ----------- ------------- ------------
  **Community/Site**   **Description**   **Quantity**   **Unit      **Extended    
                                                        Cost**      Cost**        

                                                                    **Rural       **Non-loan
                                                                    Development   Funds**
                                                                    Loan Funds**  

                                                                                  

                                                                                  

                                                                                  

                                                                                  

                                                                                  

                                                                                  

                                                                                  

                                                                                  

                                                                                  

                                                                                  

                                                                                  

                                                                                  

                                                                                  

                                                                                  

                                                                                  

                                                                                  

                                                                                  

                                                                                  

  **TOTAL**                                             []{.mark}   []{.mark}     
  -------------------- ----------------- -------------- ----------- ------------- ------------

**[Schedule Q-6]{.smallcaps}**

**Breakdown of TOWERS COSTS**

  -------------------- ----------------- -------------- ----------- ------------- ------------
  **Community/Site**   **Description**   **Quantity**   **Unit      **Extended    
                                                        Cost**      Cost**        

                                                                    **Rural       **Non-loan
                                                                    Development   Funds**
                                                                    Loan Funds**  

                                                                                  

                                                                                  

                                                                                  

                                                                                  

                                                                                  

                                                                                  

                                                                                  

                                                                                  

                                                                                  

                                                                                  

                                                                                  

                                                                                  

                                                                                  

                                                                                  

                                                                                  

                                                                                  

                                                                                  

                                                                                  

  **TOTAL**                                             []{.mark}   []{.mark}     
  -------------------- ----------------- -------------- ----------- ------------- ------------

**[Schedule Q-7]{.smallcaps}**

**Breakdown of CUSTOMER PREMISE EQUIPMENT COSTS**

  -------------------- ----------------- -------------- ----------- ------------- ------------
  **Community/Site**   **Description**   **Quantity**   **Unit      **Extended    
                                                        Cost**      Cost**        

                                                                    **Rural       **Non-loan
                                                                    Development   Funds**
                                                                    Loan Funds**  

                                                                                  

                                                                                  

                                                                                  

                                                                                  

                                                                                  

                                                                                  

                                                                                  

                                                                                  

                                                                                  

                                                                                  

                                                                                  

                                                                                  

                                                                                  

                                                                                  

                                                                                  

                                                                                  

                                                                                  

                                                                                  

  **TOTAL**                                             []{.mark}   []{.mark}     
  -------------------- ----------------- -------------- ----------- ------------- ------------

**[Schedule Q-8]{.smallcaps}**

**Breakdown of OPERATING EQUIPMENT COSTS**

  -------------------- ----------------- -------------- ----------- ------------- ------------
  **Community/Site**   **Description**   **Quantity**   **Unit      **Extended    
                                                        Cost**      Cost**        

                                                                    **Rural       **Non-loan
                                                                    Development   Funds**
                                                                    Loan Funds**  

  ***Office                                                                       
  Equipment***                                                                    

                                                                                  

                                                                                  

                                                                                  

                                                                                  

  ***Sub-Total***                                                                 

  ***Office                                                                       
  Furniture***                                                                    

                                                                                  

                                                                                  

                                                                                  

                                                                                  

  ***Sub-Total***                                                                 

  ***Work Equipment***                                                            

                                                                                  

                                                                                  

                                                                                  

                                                                                  

  ***Sub-Total***                                                                 

  ***Vehicles***                                                                  

                                                                                  

                                                                                  

  ***Sub-Total***                                                                 

  **TOTAL**                                             []{.mark}   []{.mark}     
  -------------------- ----------------- -------------- ----------- ------------- ------------

**[Schedule Q-9]{.smallcaps}**

**Breakdown of ENGINEERING COSTS**

  ------------------------------- --------------------- -----------------
  **Description**                 **Total Engineering   
                                  Costs**               

                                  **Rural Development   **Non-loan
                                  Loan Funds**          Funds**

                                                         

                                                        

                                                        

                                                        

                                                        

                                                        

                                                        

                                                        

  **TOTAL**                                             
  ------------------------------- --------------------- -----------------

**[Schedule Q-10]{.smallcaps}**

**Breakdown of notes to be refinanced**

  ------------------------------- --------------------- -----------------
  **Note**                        **Outstanding         **Maturity**
                                  Principal Amount**    

                                                         

                                                        

                                                        

                                                        

                                                        

                                                        

                                                        

                                                        

  **TOTAL**                                             
  ------------------------------- --------------------- -----------------

**[Schedule Q-11]{.smallcaps}**

**Breakdown of ACQUISITION COSTS**

  ----------------------------------- ------------------ -----------------
  **Description**                     **Total            
                                      Acquisition Cost** 

                                      **Rural            **Non-loan
                                      Development Loan   Funds**
                                      Funds**            

                                                          

                                                         

                                                         

                                                         

                                                         

                                                         

                                                         

                                                         

  **TOTAL**                                              
  ----------------------------------- ------------------ -----------------

**[Schedule R\
Environmental Report]{.smallcaps}**

**[Schedule S]{.smallcaps}**

**[Tower, equipment, and Building Leases]{.smallcaps}**

**[Schedule T-1]{.smallcaps}**

**[FCC Licenses]{.smallcaps}**

**[Schedule T-2]{.smallcaps}**

**[CLEC Licenses]{.smallcaps}**

**[Schedule T-3]{.smallcaps}**

**[Franchise Agreements]{.smallcaps}**

**[Schedule T-4]{.smallcaps}**

**[Interconnection Agreements or Service Provider
Agreements]{.smallcaps}**

**[Schedule T-5]{.smallcaps}**

**[Management / Service Agreements with Affiliated
Companies]{.smallcaps}**

**[Schedule T-6]{.smallcaps}**

**[Bylaws or Operating Agreements]{.smallcaps}**

**[Schedule T-7]{.smallcaps}**

**[Other Major Agreements]{.smallcaps}**

**[Schedule U-1]{.smallcaps}**

**[Guaranteed Loan Information]{.smallcaps}**

**[Schedule U-2]{.smallcaps}**

**[Guaranteed Loan Contract]{.smallcaps}**