*Pages 1--3 from  Microsoft Word - 15372*
 For  each  area  listed  above,  identify  the  emergency  response  point  to  which  calls  are  now  being  routed. 
 Section  3  Certification  -  To  be  signed  by  an  authorized  representative  of  the  reporting  entity 
 I  certify  that  I  am  an  authorized  representative  of  the  above-  named  reporting  entity,  that  I  have  examined  the  foregoing  report  and  to  the  best  of  my  knowledge,  information  and  belief,  all  statements  of  fact  contained  in  this  form  are  true  and  that  the  reporting  entity  has  completed  the 
 steps  necessary  to  properly  route  911  emergency  calls  in  the  localities  covered  by  the  report  as  of  _______________. 


 Signature 
 Printed  name  of  authorized  representative 


 Title 
 Date 


 This  filing  is:  original  filing  revised  filing 


 PERSONS  MAKING  WILLFULL  FALSE  STATEMENTS  IN  THIS  DOCUMENT  CAN  BE  PUNISHED  BY  FINE  OR  IMPRISONMENT  UNDER  TITLE  18  OF  THE  UNITED  STATES  CODE,  18  U.  S.  C.  §1001. 
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