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Southwestern Bell Telephone
Southwestern Bell Telephone Company:
NOTIFICATION OF SURRENDER OR MODIFICATION
OF POLE ATTACHMENT LICENSE BY LICENSEE
SW-9436A
(Rev. 5-89)
Ref: 002-011-900SW
Page of
In accordance with the terms and conditions of the Licensee Agreement between us, dated , notice is hereby
given that the licenses covering attachments to the following poles and/or anchors and/or utilization of anchor/guy strand is
surrendered (or modified as indicated in Licensee's prior notification to Licensor, dated , ) effective .
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POLE NO.
Date Notification Received:
Date Modification Accepted:
ANCHOR A/GS
(ASSOC. POLE. NO.)
LIC. NO. & DATE SURRENDER OR MODIFICATION
By: Name of Licensee
Discontinued:
Poles: By:
Anchors:
Anchor/Guy Strands: Title:
Official File Copy, If Checked in Red
DATE FAC.
RMVD. OR
MODIFIED