FCC License Assistance Request Form

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Alien Ownership Questions

(If any answer is “Yes”, please explain the circumstances in the "Explanation" area at the bottom of this page.)

1. Is the Applicant a foreign government or the representative of any foreign government?(*)

Please tell us if the Applicant is a foreign government or the representative of any foreign government.

2. Is the Applicant an alien or the representative of an alien?(*)

Please tell us if the Applicant is an alien or the representative of an alien?

3. Is the Applicant a corporation organized under the laws of any foreign government?(*)

Please tell us if the Applicant is a corporation organized under the laws of any foreign government?

4. Is the Applicant a corporation of which more than one-forth of the capital stock is owned of record or voted by aliens or their representatives or by a foreign government or representative thereof or by any corporation organized under the laws of a foreign country?(*)

Please tell us if the Applicant is a corporation of which more than one-forth of the capital stock is owned of record or voted by aliens or their representatives or by a foreign government or representative thereof or by any corporation organized under the laws of a foreign country.

5a. Is the Applicant directly or indirectly controlled by any other corporation of which more than one-fourth of the capital stock is owned of record or voted by aliens, their representatives, or by a foreign government or representative thereof, or by any corporation organized under the laws of a foreign country?(*)

Please tell us if the Applicant is directly or indirectly controlled by any other corporation of which more than one-fourth of the capital stock is owned of record or voted by aliens, their representatives, or by a foreign government or representative thereof, or by any corporation organized under the laws of a foreign country.

5b. If the answer to 5a is “Y”, has the Applicant received a ruling(s) under Section 310(b)(4) of the Communications Act with respect to the same radio service(s) and geographic coverage area(s) involved in this filing?

6. Has the Applicant or any party to this application had any FCC station authorization, license or construction permit revoked or had any application for an intial, modification, or renewal of FCC station authorization, license, or construction permit denied by the comission?(*)

Please tell us if the Applicant or any party to this application had any FCC station authorization, license or construction permit revoked or had any application for an intial, modification, or renewal of FCC station authorization, license, or construction permit denied by the comission.

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General Certification Statements:

1. The Applicant waives any claim to the use of any particular frequency or the electromagnetic
spectrum as against the regulatory power of the United States because of the previous use of the
same, whether by license or otherwise, and requests an authorization in accordance with this
application.

2. The Applicant certifies that the grant of this application would not cause the Applicant to be in
violation of any pertinent cross-ownership or attribution rules. *
(*If the Applicant has sought a waiver of any such rule in connection with this application, it may make this
certification subject to the outcome of the waiver request to the outcome of the waiver request.)

3. The Applicant certifies that all statements made in this application and in the exhibits,
attachments, or documents incorporated by reference are material, are part of this application,
and are true, complete, correct, and made in good faith.

4. The Applicant certifies that neither the Applicant nor any other party to the application is subject
to a denial of Federal benefits pursuant to § 5301 of the Anti-Drug Abuse Act of 1988, 21 U.S.C.
§ 862, because of a conviction for possession or distribution of a controlled substance. This
certification does not apply to applications filed in services exempted under §1.2002(c) of the
rules, 47 CFR § 1.2002(c). See § 1.2002(b) of the rules, 47 CFR § 1.2002(b), for the definition of
“party to the application” as used in this certification.

5. The Applicant certifies that it either (1) has current required ownership data on file with the
Commission, (2) is filing updated ownership data simultaneously with the application, or (3) is not
required to file ownership data under the Commission’s rules.

6. The Applicant certifies that the facilities, operations, and transmitters for which this authorization
is hereby requested are either: (1) categorically excluded from routine environmental evaluation
for RF exposure as set forth in 47 C.F.R. 1.1307(b); or, (2) have been found not to cause human
exposure to levels of radio frequency radiation in excess of the limits specified in 47 C.F.R. 1.1310
and 2.1093; or, (3) are the subject of one or more Environmental Assessments filed with the
Commission.

7. The Applicant certifies that it has reviewed the appropriate Commission Rules defining eligibility to
hold the requested license(s), and is eligible to hold the requested license(s).
8. The Applicant certifies that it is not in default on any payment for Commission licenses and that it
is not delinquent on any non-tax debt owed to any federal agency.

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Purpose of Application

Purpose of Application (Select One)

New

Modification

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If "Modification" Provide call sign(s)

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Modification(s) Requested

Please type the Modification(s) Requested.

Control Point Address

Please type the Control Point Address.

City

Please type the Control Point City.

County

Please type the Control Point County.

State

Please type the Control Point State.

Phone

Please type the Control Point Phone Number.

Eligibility (Describe Applicant’s business)

Please type the Eligibility (Describe Applicant’s business).

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Model(s) of Equipment Used

Model Number(*)

Please type the Model Number.

Frequency Band Requested(*)

Please type the Frequency Band Requested.

How Many of Each Equipment Model Above Are Your Using?(*)

Please type How Many of Each Equipment Model You Are Using.

Applicant and any party to this application agrees, or any party directly or indirectly controlling the Applicant, to never have been convicted of a felony by any state or federal court. Applicant also agrees that no court has adjudged the applicant or any party directly or indirectly controlling the applicant guilty of unlawfully monopolizing or attempting unlawfully to monopolize radio communication, directly or indirectly, through control of manufacture or sale of radio apparatus, exclusive traffic arrangement, or any other means or unfair methods of competition.

(*)

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