COMPLETE ONLY THE PARTS OF THIS FORM THAT APPLY

ALL COMPANIES MUST COMPLETE THE LAST PART

Notice of Formation, Consolidation or Discontinuance

of the

Company

To the Department of Public Utility Control of the State of Connecticut:

The undersigned Secretary of the above-named Company, in accordance with the provisions of Section 1644 of the General Statutes of Connecticut, gives notice as follows:

Notice of the Formation of a Public Service Company

That the / Company
was chartered by the General Assembly of the State of Connecticut at its
Session of (year) / for the purpose of: (insert here a brief statement of the kind of service authorized by
charter to be carried on.)
That on the / day of / (year) / said Company was duly
organized at / in said State under the provisions of said Charter
for the commencement of business in the State of Connecticut and the following officers were elected:

namepost office address

President
Vice-President
Secretary
Treasurer

Notice of the Commencement of Business by a Foreign Public Service Company

That the said / Company
has leased or otherwise acquired the rights and privileges heretofore held by the
Company has
and commenced business in the State of Connecticut on the / day of
(year)

That the names and addresses of its officers are:

namepost office address

President
Vice-President
Secretary
Treasurer

Notice of the Consolidation of a Public Service Company

That the said / Company
on the / day of / (year) / by a vote of a majority of its
Stockholders voted to merge with the / Company
which Company was chartered by the / of the State of
at its / Session / (year)
and on the / day of / (year) / Said merger or consolidation
became effective and said / Company
(insert here the present status of the Company)

Notice of the Discontinuance of a Public Service Company

That the said Company by a vote of a majority of its stockholders on the / day of
(year) / voted to permanently discontinue doing business as a public service
Company in the State of Connecticut, such discontinuance to take effect on the / day of
(year) / That

For All Companies

That the principal business office of the reporting Company is located at:

Street and Number
Town or City
State of

That the person to whom official communications from the Department of Public Utility Control should be addressed is:

Name
Title
Street and Number
Town or City
State of
Dated at / this / day of / 200

Secretary

Subscribed and sworn to before me

this / day of / 20

Return to:Executive Secretary

Department of Public Utility Control

10 Franklin Square

New Britain, CT 06051