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<br />EXHIBIT G <br /> <br />SAMPLE CABLE TV TOTAL GROSS REVENUE REPORTING FORM <br /> <br />For the calendar quarter ending: <br /> <br />ADELPHIA CABLEVISION OF SANTA ANA, LLC <br />Statement of Gross Receipts <br />Franchise: Santa Ana, CA <br />Period: <br /> <br />Service Cateeorv Latest Month Subs Gross Amount <br />BASIC <br />CABLEV ALUE/CABLESELECT <br />DIGITAL PROGRAMMING <br />NON-STANDARD SERVICE <br />ADDITiONAL OUTLETS <br />CINEMAX <br />DIGITAL TV - PPY <br />DIGITAL VIDEO RECORDER <br />ENCORE <br />FOX SPORTS <br />HBO <br />MUSIC CHOICE <br />PLAYBOY- PAY <br />SHOWTiME <br />STARZ <br />IN DEMAND <br />PAY PER VIEW <br />PLAYBOY PPV <br />INSTALLATiONS <br />CABLESELECT BOX <br />CONVERTERS <br />REMOTES <br />LATE CHARGES <br />MISCELLANEOUS <br />NET ADVERTISING <br />HNS DISTRIBUTiON <br />HOME SHOPPING <br />QVC <br />QVC REPOSITIONING <br />LOCAL ORIGINATION <br />LEASE/OTHER RENTAl. <br />OTHER NON-SUBSCRIHER <br /> <br />Gross Receipts <br /> <br />Deductions from Gross Receipts <br />(see detail below) <br /> <br />Bad Debt <br />Programming Expenses <br /> <br />Net Receipts <br /> <br />Franchise Fcc % <br /> <br />x <br /> <br />% <br /> <br />Gross Franchise Fft' (calculated over total period) <br />Rounding Adjustment <br /> <br />Cross Franchise Fcc <br /> <br />I 2097-0002\680672vl 9.doc <br /> <br />G-] <br /> <br />City of Santa Ana <br />EXECUTION COPY 4/07/05 <br />