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CERTIFICATE OF EXEMPTION FROM FEDERAL EXCISE TAX ON COMMUNICATIONS SERVICES AND FACILITIES The undersigned hereby certifies that the services furnished by tJ e. i-+"f., I are exempt from the Federal Excise Tax on communications services and facilities because the organization Is exempt under Internal Revenue Code 4253 as marked below. At such time when the claimed status no longer applies, written notice of recisIon will be submitted. () A nonprofit hospital referred to in Internal Revenue Code Section 170(b)(1)(A)(ili) which is exempt from Income tax under Section S01(a). () A nonprofit educational organization described in Internal Revenue Code Section 170(b)(1}(A)(II) which Is exempt from income tax under Section 501 (a). (X) The government of the United States, or the government of any state or its political subdivisions or the District of Columbia. () An international organization described in Internal Revenue Code Section 4253(b). ( , ) The service will be used exclusively In the rendering of a communications service upon which tax is imposed by Internal Revenue Code Section 4251. It Is understood that no tax will be collected by or charges for said services and that it will be the responsibility of the undersigned to collect such tax as may be due from Its customers. () Common carriers and communications companies. Certain communications 'facilities used by common ,carriers are exempt. A common carrier is one holding itself out to the public as engaged in the business of transportation of persons or property from place to place for compensation, offering its services to the pu bllc generally. Exempt status effective as of s- ~- t)3 ANY MODIFICATIONS TO THE ABOVE WILL RENDER THIS CERTIFICATE NULL AND VOID ORGANIZATION: &..&'5 ~#rY #'4IY~ ..&-~.r~?;J:;e ~~) ADDRESS /.Zt?/ ~. ,A/-f';-# ~~ ~)'J/ #4 FEDERAL TAX ID~ NUMBER: BY (Signature): ~ 4 t!!rl/r- 6F"J/,q' - /~/J / ~~ ~~O zzos- Title: Date: 3//'- ~~