(This form to be printed or typewritten on paper 8 by 10 1/2 inches in size)
_____________________ (Name of petitioning company)
__________19 _______ (Place and date)
To: PENNSYLVANIA PUBLIC UTILITY COMMISSION HARRISBURG, PENNSYLVANIA 17120
The ________ (Name of petitioning company) does respectfully petition the Commission that it be permitted under article III, section 308 of the Public Utility Law (66 P. S. § 1101et seq.) to put in force the following rates, to become effective _____ day(s) after the filing thereof with the Commission. (State fully the rates it is desired to put into effect, the article upon which they are to apply, and the points affected.)
_______________________________________________________________________________________________
_______________________________________________________________________________________________
Your petitioner further represents that the rates above mentioned will be published in Tariff Pa. P.U.C. No. ______ or in Supplement No. ______ to Tariff Pa. P.U.C. No. ________ and will supersede and take the place of the rates on like tariff from and to the points above named which are set forth in Tariff Pa. P.U.C. No.______or Supplement No. to ______ Tariff Pa. P.U.C. No. ______ on file with the Commission.
And your petitioner further bases such request upon the following facts, which present certain special circumstances and conditions justifying the request herein made:
(State fully all the circumstances and conditions which are relied upon as justifying the application, and if based upon rates in effect via other lines, specific reference shall be given to the Pa. P.U.C. numbers of the tariffs of such other line or lines)
_______________________________________________________________________________________________
(Name of petitioning company)
By _______________________________________________________________________________________________
(Name of officer, personal signature)
_______________________________________________________________________________________________
(Title of officer)
(Affidavit)
52 Pa. Code § 23.71