Free 175 - Federal

Federal Communications Commission Washington, D. C. 20554 Application to Participate in an FCC Auction (Read Instructions Before Completing) 1. Applicant

Special Use FCC Use Only 8. Applicant Classification: Partnership Trust LLC Individual Corporation Govt. Entity

Approved by OMB 3060-0600

Joint Venture Consortium Association

2. Mail Address (No P.O. Boxes)
5. ZIP Code

9. Applicant Status: Rural telephone company Minority owned business Woman owned business

3. City

4. State

10. Bidding Credit Eligibility ___% Bidding Credit Percentage Small Business Very Small Business New Entrant
11. Entrepreneur Eligibility (if appropriate) Total assets and gross revenues do not exceed the maximum dollar amounts

6. Auction Number

7. Taxpayer Identification No.

Noncommercial Educational None of the above

12. Licenses or construction permits for which you want to bid. If bidding for Wireless licenses, use Schedule A. If bidding for Broadcast construction permits, use Schedule B. 13.
Check here if exhibits are attached. Indicate number of supplemental exhibits attached:

14. Person(s) authorized to make or withdraw a bid (Identify up to three.) (a) Certification: I certify the following: (b) (c)

(1) that the applicant is legally, technically, financially and otherwise qualified pursuant to 308(b) of the Communications Act and the Commission's Rules and is in compliance with the foreign ownership provisions contained in Section 310 of the Communications Act. (2) that the applicant is the real party in interest in this application and that there are no agreements or understandings other than those specified in this application (see Instructions for certification), which provide that someone other than the applicant shall have an interest in the license. (3) that the applicant is aware that, if upon Commission inspection, this application is shown to be defective, the application may be dismissed without further consideration, and certain fees forfeited. Other penalties may also apply. (4) except as explicitly provided in the Commission's Rules, that the applicant has not entered into and will not enter into any explicit or implicit agreements or understandings of any kind with parties not identified in this application regarding the amount to be bid, bidding strategies or the particular license on which the applicant or other parties will or will not bid. (5) that the applicant, or any party to this application, is not subject to a denial of federal benefits pursuant to Section 5301 of the Anti-Drug Abuse Act of 1988. (6) that if a bidding credit eligibility is claimed in block 10, the applicant is eligible for any special provisions set forth in the Commission's Rules applicable to this auction and consents to audits, as set forth in the Commission's Rules, to verify such status. (7) that the applicant is and will, during the pendency of its application(s), remain in compliance with any service specific qualifications applicable to the licenses on which the applicant intends to bid including, but not limited to, financial qualifications. (8) that the applicant 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. I declare, under penalties of perjury, that I am an authorized representative of the above-named applicant for the license(s) and/or construction permits specified above, that I have read the instructions and the foregoing certification and all matters and things stated in this application, its schedules and attachments, including exhibits, are true and correct.
15. Name of Person Certifying 16. Contact Person Contact Person Address (No P.O. Boxes) Title of Person Certifying Date E-mail Address FAX No. City Telephone No. State ZIP Code

Willful false statements made on this form are punishable by fine and/or imprisonment (U.S. Code, Title 18, Section 1001), and/or revocation of any station license or construction permit (U.S. Code, Title 47, Section 312(a)(1)), and/or forfeiture (U.S. Code, Title 47, Section 503).

FCC 175 October 2000

Federal Communications Commission Washington, D. C. 20554

Application to Participate in an FCC Auction Schedule A (FCC Form 175)
(This schedule is to be used when applying to bid for wireless licenses/markets.)

Approved by OMB 3060-0600

Applicant

Auction No.

FCC Account No.

Markets and Frequency Blocks/Channels for which you want to bid.
Market No.

ALL (a) (b) (c) (d) (e) (f) (g) (h) (i) (j) (k) (l) (m) (n)

Frequency Block/Channel No. Enter Frequency Block/Channel Number(s) or Letter(s) or Check All

ALL

The Communications Act of 1934, as amended, authorized the FCC to collect the personal information requested on this form. We will use the information provided to determine whether approving this application is in the public interest. If we believe there may be a violation or potential violation of any statute, or FCC rule, regulation or order, your application may be referred to the Federal, state or local agency responsible for investigating, prosecuting, enforcing or implementing the statute, rule, regulation or order. In certain cases, the information on your application may be disclosed to the Department of Justice or a court or adjudicative body when (a) the FCC; (b) any employee of the FCC; or (c) the United States Government, is a party to the proceeding before the body or has an interest in the proceeding. If you owe a delinquent debt to the federal government, the TIN and other information provided may also be disclosed to the Department of Treasury Financial Management Services, other federal agencies and/or your employer to offset your salary, IRS tax refund or other payments to collect that debt. The FCC may also provide this information to these agencies through the matching of computer records when authorized. With the exception of the TIN, any information provided on this form will be available for public inspection. Public reporting burden for this information (including FCC Form 175 and this Schedule) is estimated to average 1.5 hours per response, including the time for reviewing instructions, searching existing data needed, gathering and maintaining the data needed, and completing and reviewing the collection. You are not required to respond to a collection of information sponsored by the Federal Government, unless it displays a currently valid OMB control number. The control number for this collection is 3060-0600. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing the burden, to the Federal Communications Commission, Paperwork Reduction Project (3060-0600), Performance Evaluation and Records Management, Washington, D. C. 20554. DO NOT SEND COMPLETED APPLICATION FORMS TO THIS ADDRESS. THE FOREGOING NOTICE IS REQUIRED BY THE PRIVACY ACT OF 1974, P.L. 93-579, DECEMBER 31, 1975, 5 U.S.C. SECTION 552a(e)(3) AND THE PAPERWORK REDUCTION ACT OF 1995, P.L. 104-13, 44 U.S.C. SECTION 3507. FCC 175 (Schedule A) October 2000

Federal Communications Commission Washington, D. C. 20554

Application to Participate in an FCC Auction Schedule B (FCC Form 175)
(This schedule is to be used when applying to bid for broadcast construction permits/facilities.)

Approved by OMB 3060-0600

Applicant

Auction No.

Taxpayer Identification No.

Broadcast facilities for which you want to bid.
Service New or Major Channel/ Frequency Community of License: City State File No. (if applicable)

(a) (b) (c) (d) (e) (f) (g) (h) (i) (j) (k) (l) (m) (n) (o)
The Communications Act of 1934, as amended, authorized the FCC to collect the personal information requested on this form. We will use the information provided to determine whether approving this application is in the public interest. If we believe there may be a violation or potential violation of any statute, or FCC rule, regulation or order, your application may be referred to the Federal, state or local agency responsible for investigating, prosecuting, enforcing or implementing the statute, rule, regulation or order. In certain cases, the information on your application may be disclosed to the Department of Justice or a court or adjudicative body when (a) the FCC; (b) any employee of the FCC; or (c) the United States Government, is a party to the proceeding before the body or has an interest in the proceeding. If you owe a delinquent debt to the federal government, the TIN and other information provided may also be disclosed to the Department of Treasury Financial Management Services, other federal agencies and/or your employer to offset your salary, IRS tax refund or other payments to collect that debt. The FCC may also provide this information to these agencies through the matching of computer records when authorized. With the exception of the TIN, any information provided on this form will be available for public inspection. Public reporting burden for this information (including FCC Form 175 and this Schedule) is estimated to average 1.5 hours per response, including the time for reviewing instructions, searching existing data needed, gathering and maintaining the data needed, and completing and reviewing the collection. You are not required to respond to a collection of information sponsored by the Federal Government, unless it displays a currently valid OMB control number. The control number for this collection is 3060-0600. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing the burden, to the Federal Communications Commission, Paperwork Reduction Project (3060-0600), Performance Evaluation and Records Management, Washington, D. C. 20554. DO NOT SEND COMPLETED APPLICATION FORMS TO THIS ADDRESS. THE FOREGOING NOTICE IS REQUIRED BY THE PRIVACY ACT OF 1974, P.L. 93-579, DECEMBER 31, 1975, 5 U.S.C. SECTION 552a(e)(3) AND THE PAPERWORK REDUCTION ACT OF 1995, P.L. 104-13, 44 U.S.C. SECTION 3507. FCC 175 (Schedule B) October 2000

Instructions Item 1. Applicant Name: Enter the legal name of the person or entity applying to participate in an auction. If other than an individual, insert the exact name of the entity as it appears on the legal document(s) establishing the entity, such as the Articles of Incorporation. [NOTE: Applicants who have entered into an arrangement(s) of any kind relating to the license(s) and/or construction permit(s) specified in this application must provide additional information. See Exhibit instructions below.] Item 2. Applicant Mailing Address: Enter the street address (no Post Office Boxes) suitable for mail or private parcel delivery, for the applicant Item 3. City: Enter the city name for the applicant mailing address. Item 4. State: Enter the two-letter state abbreviation. Item 5. ZIP Code: Enter the Zip Code for the applicant address. Item 6. Auction Number: Enter the appropriate auction number supplied by the Commission in the Public Notice. Item 7. Taxpayer Identification Number: Enter your nine-digit Taxpayer Identification Number (TIN). The Taxpayer Identification Number is your Employer Identification Number (EIN) or your Social Security Number (SSN), as reported to the Internal Revenue Service (IRS). Item 8. Applicant Classification: Place an [X] in the appropriate box preceding the type of legal entity applying. Limited Liability Companies should check the "LLC" box. Unincorporated Associations should check the "Association" box. Governmental Entities should check the "Gov't Entity" box. All partnerships should check the "Partnership" box and indicate in an exhibit whether they are a general or limited partnership. Item 9. Applicant Status: Place an [X] in the appropriate box or boxes preceding the type of entity. The definition of "noncommercial educational" entity applies to broadcast applicants only and is contained in 47 U.S.C. 397(6) and 47 C.F.R. § 73.503(a) (for radio) and 47 C.F.R. § 73.621(a) (for television). The definitions for "rural telephone company", "minority owned business", and "woman owned business" are contained in 47 C.F.R. § 1.2110. Applicant status information concerning rural telephone companies, minority-owned businesses and women-owned businesses is collected for statistical purposes only. Item 10. Bidding Credit Eligibility: If bidding in a wireless auction, place an [X] in the box preceding the Small Business or Very Small Business designated entity type, if appropriate. This information will be used for determining the applicant's eligibility for special provisions available for wireless designated entities. For definitions of the types of designated entities, see the Commission's Rules at 47 C.F.R. Part 1, Subpart Q and the specific Commission Rules governing the wireless service for which you are applying. If bidding in a broadcast auction, place an [X] in the box preceding the New Entrant designated entity type, if appropriate. This information will be used for determining the applicant's eligibility for the New Entrant bidding credit available for designated entities. See 47 C.F.R. §§ 73.5007 & 73.5008. All designated entities must specify which percent bidding credit applies. Applicants ineligible for a bidding credit should leave the question blank. In addition, applicants claiming eligibility for the Small Business or Very Small Business bidding credit, must set forth, in an exhibit, the applicant's gross revenues, and its affiliates' gross revenues, in accordance with the Commission's Rules governing the auctionable service. Applicants claiming eligibility for the New Entrant bidding credit must list, in an exhibit, the applicant's other media of mass communications in accordance with 47 C.F.R. §§ 73.5007 & 73.5008. Item 11. Entrepreneur Eligibility. If bidding in a wireless auction, place an [X] in the box preceding the Entrepreneur Eligibility, if appropriate. This will signify that the applicant is qualified to bid in an entrepreneur block auction. For the rules concerning eligibility, see 47 C.F.R. 24.709. Item 14. Authorized Bidders: Enter the name(s) of the person(s) you wish to designate as an authorized representative(s). Only authorized representatives will be allowed to make or withdraw bids at an auction. You may list a maximum of three (3) authorized representatives. Item 15. Certification: Enter the name of the individual authorized to submit the application, his/her title, date of submission. Item 16. Contact person/address: Enter the name of a person familiar with the application (contact person) and the address, phone number, fax number (including area code), and e-mail address of the contact person. All written and verbal communications and registration information will be directed to the applicant's contact person at the address/phone number specified on the FCC Form 175. NOTE: The Commission's Public Notice announcing the auction of the facilities for which you are interested in bidding, and related documents, contain information essential to completing this form correctly. You should also consult the specific rules governing the service in which you are applying. Forms which are completed incorrectly may be dismissed without an opportunity for resubmission. Schedule A - Wireless Facilities: Enter the code for the market(s) on which you want to bid in the column under Market No. The codes will be provided by the Commission in a Public Notice. Use a separate line for each different market. If you want to be eligible to bid on licenses in all markets, you should place an [X] in the box marked "ALL." After each market, list the letter(s) or number(s) for the frequency block(s) or channel(s) on which you intend to bid. These codes will be provided by the Commission in a Public Notice. For example, if you want to bid on two frequency blocks in market (a) and one block in market (b), to be eligible you would enter the codes for the two desired frequency block(s) in market (a) in columns 1 and 2 on line (a) and leave the remaining columns on that line blank. On line (b) you would enter in column 1 the code for the frequency block you want in market (b) and leave the remaining columns on the line blank. If you want to be eligible to bid on all frequency blocks in all available markets, you should place an [X] in the box marked "ALL". Schedule B - Broadcast Facilities: Enter the name of the service for the facility on which you intend to bid using the following code designators: AM Radio - AM; FM Radio - FM; Full Power Television - PST; FM Translator - FMT; TV Translator and Low Power Television SST. Use a separate line for each different facility. Indicate whether the facility for which you want to bid is a new facility or a "major modification" to an existing facility, as defined in 47 C.F.R. § 73.3571(a)(1) (AM Radio), § 73.3572(a)(1) (Full Power Television, Low Power Television and Television Translators), § 73.3573(a)(1) (FM Radio), and § 74.1233(a)(1) (FM Translators). If you intend to bid on an AM Radio facility, enter the Frequency of that facility; otherwise enter the Channel number. Enter the Community of License (both City and State) of the facility for which you intend to bid. Enter the File Number of the pertinent broadcast application (i.e., FCC Form 301 for AM, FM and television stations; FCC Form 346 for LPTV and television translators, or FCC Form 349 for FM Translators) you have filed for the facility on which you intend to bid, if applicable. Item 13. Exhibits. If exhibits are attached to the application, check the box provided and indicate the number of exhibits. List in an exhibit the name, citizenship and address of all partners, if the applicant is a partnership; of a responsible officer or director, if the applicant is a corporation; of the trustee, if the applicant is a trust; or if the applicant is none of the foregoing, list the name, address and citizenship of a principal or other responsible person. See 47 C.F.R. § 1.2105(a). In addition, list in an exhibit the specific ownership information as set forth in 47 C.F.R. § 1.2112. Also list in an exhibit all parties with whom the applicant has entered into an agreement(s), of any kind, relating to the facilities being auctioned including, where applicable, such agreement(s) relating to the post-auction market structure. See 47 C.F.R. § 1.2105(a). For broadcast applicants, the anti-collusion provisions of 47 C.F.R. Part 1 are modified pursuant to 47 C.F.R. § 73.5002(d).

Item 12. Facilities for which you want to bid. If bidding for wireless licenses, use Schedule A. If bidding for broadcast construction permits, use Schedule B. In addition, see the specific instructions for Schedules A and B.

October 2000