LPFM Application Data 

Note:

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Application Technical Information:

1. Full Legal Name of Applicant:

   
   

2. Full Mailing Address of Applicant:

   
   

3. Proposed City of License:

   
   

4. Zip Code:

   
   

5. Telephone Number:

   
   

6. Fax Number:

   
   

7. E-mail Address:

   
   

8. Contact Representative (Can be us):

   
   

9. Firm or Company of Contact Representative:

   
   

10. Telephone Number of Contact Representative:

    
    

11. Fax Number of Contact Representative:

    
    

12. E-mail Address of Contact Representative:

    
    

13. Application Purpose:

    New station Major change in licensed facility Minor change in licensed facility Major modification of construction permit Minor modification of construction permit Amendment to pending application I'm not really sure and need you to determine the correct answer
    

14. If your answer to the "Application Purpose" question is uncertain, please briefly explain the situation:

    
    

15. File Number of Original Construction Permit (If applicable):

    
    

16. Proposed City of License (City with which you would you like to closely associate your station):

    
    

17. State in which Proposed City of License is Located:

    
    

18. Are you serious and truthful in the filing of this application? Have you studied the requirements and are you fully prepared to build and operate this proposed broadcast station to the best of your abilities?:

    Yes No Can I think about that?
    

19. Are you a non-profit, educational institution (school, etc.)?:

    Yes No Can I think about that?
    

20. Are you a non-profit, educational organization (civic group or club, etc.)?:

    Yes No Can I think about that?
    

21. If you answered "Yes" to any of the above two questions, please give a brief explanation and some background information on your institution or organization:

    
    

22. Are you a Public Safety Service having JURISDICTION (as in Police, Fire department, etc.) in the area to be served by the proposed station?:

    Yes No Can I think about that?
    

23. Party Number 1: Please List Name, Citizenship, Position (Officer, Director, General Partner, Limited Partner, LLC Member, or Investor/Creditor attributable under the Commission's equity/debt plus standard, Percentage of Votes and Percentage of Total Assets (equity plus debt):

    Name
    Title
    Organization
    Street Address
    Address (cont.)
    City
    State/Province
    Zip/Postal Code
    Country
    Phone
    FAX
    E-mail
    % of Votes
    % of Assets

24. Party Number 2: Please List Name, Citizenship, Position (Officer, Director, General Partner, Limited Partner, LLC Member, or Investor/Creditor attributable under the Commission's equity/debt plus standard, Percentage of Votes and Percentage of Total Assets (equity plus debt):

    Name
    Title
    Organization
    Street Address
    Address (cont.)
    City
    State/Province
    Zip/Postal Code
    Country
    Phone
    FAX
    E-mail
    % of Votes
    % of Assets

25. Party Number 3: Please List Name, Citizenship, Position (Officer, Director, General Partner, Limited Partner, LLC Member, or Investor/Creditor attributable under the Commission's equity/debt plus standard, Percentage of Votes and Percentage of Total Assets (equity plus debt):

    Name
    Title
    Organization
    Street Address
    Address (cont.)
    City
    State/Province
    Zip/Postal Code
    Country
    Phone
    FAX
    E-mail
    % of Votes
    % of Assets

26. Party Number 4: Please List Name, Citizenship, Position (Officer, Director, General Partner, Limited Partner, LLC Member, or Investor/Creditor attributable under the Commission's equity/debt plus standard, Percentage of Votes and Percentage of Total Assets (equity plus debt):

    Name
    Title
    Organization
    Street Address
    Address (cont.)
    City
    State/Province
    Zip/Postal Code
    Country
    Phone
    FAX
    E-mail
    % of Votes
    % of Assets

27. Party Number 5: Please List Name, Citizenship, Position (Officer, Director, General Partner, Limited Partner, LLC Member, or Investor/Creditor attributable under the Commission's equity/debt plus standard, Percentage of Votes and Percentage of Total Assets (equity plus debt):

    Name
    Title
    Organization
    Street Address
    Address (cont.)
    City
    State/Province
    Zip/Postal Code
    Country
    Phone
    FAX
    E-mail
    % of Votes
    % of Assets

28. Do you certify that any equity and financial interests (as set forth above) are non-attributable?:

    Yes No Can I think about that?
    

29. Do you certify that you are a non-profit, educational organization that is PHYSICALLY HEADQUARTERED within 10 miles of the proposed transmitter site?:

    Yes No Can I think about that?
    

30. Do you certify that you are a non-profit, educational organization that has 75% of it's BOARD MEMBERS residing within 10 miles of the proposed transmitter site?:

    Yes No Can I think about that?
    

31. Do you certify that you are a public safety radio service and that you have JURISDICTION within the service area of the proposed transmitter site?:

    Yes No Can I think about that?
    

32. Do you certify that no party to this application has an attributable interest in any other LPFM station and/or application?:

    Yes No Can I think about that?
    

33. Do you certify that no party to this application has an attributable interest in any OTHER type of broadcast station (AM, FM, TV)?:

    Yes No Can I think about that?
    

34. Do you certify that you are in compliance with the Commission's policies relating to media interests of immediate family members?:

    Yes No Can I think about that?
    

35. Do you certify that you are in compliance with the Commission's policies relating to investor insulation and the non-participation of non-party investors and creditors?:

    Yes No Can I think about that?
    

36. Do you certify that you nor any party to the application has had any interest in or connection with any broadcast application in any proceeding where character issues were left unresolved or were resolved adversely against the applicant or party to the applicant?:

    Yes No Can I think about that?
    

37. Do you certify that you nor any party to the application has had any interest in or connection with any pending broadcast application in which character issues have been raised?:

    Yes No Can I think about that?
    

38. Do you certify that no adverse finding has been made and no adverse final action has been taken by any court or administrative body as to the applicant, any party to this application, or any non-party equity owner in the applicant, in a civil or criminal proceeding brought under the provisions of any law relating to any felony, mass media related antitrust, or unfair competition, fraudulent statements to another governmental unit or discrimination?:

    Yes No Can I think about that?
    

39. If the answer is "No", please give a brief explanation:

    
    

40. Have you ever been CAUGHT (received a letter or a visit from the FCC because of) operating an unlicensed radio station?:

    Yes No Can I think about that?
    

41. If the answer to the above question is "Yes", did you cease operations voluntarily on or before February 26, 1999?:

    Yes No Can I think about that?
    

42. Did you cease operations within 24 hours of being directed to do so by the Commission?:

    Yes No Can I think about that?
    

43. Do you certify that you or any party to the application are NOT a drug abuser?:

    Yes No Can I think about that?
    

44. Do you certify that, for a period of at least two years before the date of this application, your non-profit, educational institution or organization has been PHYSICALLY HEADQUARTERED, has HAD A CAMPUS or has had 75% of it's BOARD MEMBERS residing within 10 miles of the proposed transmitter site?:

    Yes No Can I think about that?
    

45. If the answer is "Yes", please give a brief explanation of how you can demonstrate this and how your organization is active within your community in an educational manner:

    
    

46. Do you certify that, for a period of at least two years before the date of this application, your organization (when applying as a "public safety radio service") has had JURISDICTION within the service area of the proposed station?:

    Yes No Can I think about that?
    

47. Do you certify that you will operate the station for more than 12 hours per day?:

    Yes No Can I think about that?
    

48. Do you certify that you will originate locally (from within 10 miles of the transmitter site), at least 8 hours of programming per day?:

    Yes No Can I think about that?
    

49. If you think that one or more specific frequencies MAY be available, in your area, enter it or them here. We'll do everything in our power to make it work. (But, be advised that you'll probably have to settle for "whatever's available".):

    
    

50. As accurately as possible, describe the proposed transmitter location (coordinates are nice...) Also, please tell us how far away from your first choice you'd be willing to locate your transmitter (in the even there are no useable channel assignments at the location of your first choice):

    
    

51. Do you propose the use of an existing antenna support (tower) at this site?:

    Yes No Can I think about this?
    

52. If the above answer is "Yes", how tall is the existing structure?:

    
    

53. Is the existing structure registered with the FCC?:

    Yes No I'm not sure but I'll do what I can to find out I'm not sure and I don't know how to find out Can I think about this?
    

54. If the above answer is "Yes" what is the registration number (which SHOULD be prominently displayed on a sign displayed on the gate or the tower, itself)?: