Free 350 - Federal

Federal Communications Commission Washington, D.C. 20554

Approved by OMB 3060-0404

APPLICATION FOR AN FM TRANSLATOR OR FM BOOSTER STATION LICENSE
GENERAL INSTRUCTIONS A. When to Use this Form. This FCC Form is to be used in all cases when applying for an FM translator or FM booster broadcast station license. The form consists of the following sections: I. General Information II. Legal Qualifications III. Preparer's Certification (for preparer of engineering sections of the application) and Engineering Data B. FCC Rules. This application form makes many references to FCC rules. Applicants should have on hand and be familiar with current broadcast rules in Title 47 of the Code of Federal Regulations (C.F.R.): (1) Part 0 (2) Part 1 (3) Part 73 (4) Part 74 "Commission Organization" "Practice and Procedure" "Radio Broadcast Services" "Experimental, Auxiliary, and Special Broadcast and Other Program Distributional Services" D. Paper Filing of Application Forms. Applicants that prepare this application in paper form should file an original and two copies of this application and all exhibits. Applicants should follow the procedures set forth in Part 0 and Part 74 of the Commission's Rules. Amendments to previously filed applications should be prepared and submitted in original and two copies, signed in the same manner as the original application, and should contain the following information to identify the associated application: (1) (2) (3) (4) (5) (6) (7) Applicant's name. Call letters or specify "NEW" station. Channel number. Community of license. File number of application being amended (if known). Date of filing of application being amended (if file number is not known). Facility ID Number.

FCC Rules may be purchased from the Government Printing Office. Current prices may be obtained from the GPO Customer Service Desk at (202) 512-1803. For payment by credit card, call (202) 512-1800, M-F, 8 a.m. to 4 p.m. e.s.t; facsimile orders may be placed by dialing (202) 518-2233, 24 hours a day. Payment by check may be made to the Superintendent of Documents, Attn: New Orders, P.O. Box 371954, Pittsburgh, PA 15250-7954. C. Electronic Filing of Application Forms. The Commission is currently developing electronic versions of various broadcast station application and reporting forms, such as this application form. As each application form and report goes online, the Commission will by Public Notice announce its availability and the procedures to be followed for accessing and filing the application form or report electronically via the Internet. For a six-month period following the issuance of the Public Notice, the subject application form or report can be filed with the Commission either electronically or in a paper format. Electronic filing will become mandatory, on a form-byform basis, six months after each application form or report becomes available for filing electronically.

E. Public Inspection File. A copy of the completed application and all related documents shall be made available for inspection by the public. The station records should be maintained at an accessible location in one of the communities of license of the translator or booster, except that the station records of a translator or booster owned by the licensee of the primary station rebroadcast may be kept at the same place where the primary station's records are kept. See 47 C.F.R. Sections 74.1281, 73.1125. F. Defective Applications. Applicants should provide all information requested by this application. No section may be omitted. Responses indicating "on file" are not acceptable. If any portions of the application are not applicable, the applicant should so state. Defective or incomplete applications will be returned without consideration. Inadvertently accepted applications are also subject to dismissal.

G. Current Information. In accordance with 47 C.F.R. Section 1.65, applicants have a continuing obligation to advise the Commission, through amendments, of any substantial and material changes in the information furnished in this application. This requirement continues until the FCC action on this application is no longer subject to reconsideration by the Commission or review by any court.

All previous editions obsolete.

FCC 350 Instructions April 2001

H. Worksheets and Certifications. This application requires applicants to certify compliance with many statutory and regulatory requirements. Detailed instructions provide additional information regarding Commission rules and policies. These materials are designed to track the standards and criteria which the Commission applies to determine compliance and to increase the reliability of applicant certifications. They are not intended to be a substitute for familiarity with the Communications Act and the Commission's regulations, policies, and precedent. While applicants are required to review all application instructions, they are not required to complete or retain any documentation created or collected to complete the application. I. Exhibits. This application is presented primarily in a "Yes/No" certification format. However, it contains places for submitting explanations and exhibits where necessary or appropriate. Each certification constitutes a material representation. Applicants may only mark the "Yes" certification when they are certain that the response is correct. A "No" response is required if the applicant is requesting a waiver of a pertinent rule and/or policy, or where the applicant is uncertain that the application fully satisfies the pertinent rule and/or policy. Thus, a "No" response to a certification item will not cause the immediate dismissal of the application if this form provides an "Exhibit Box" for the item, indicating that filing an exhibit is acceptable, and if an appropriate exhibit is submitted. Signatures. The applicant, or the applicant's authorized representative, must sign the application. Depending on the nature of the applicant, the application should be signed as follows: if a sole proprietorship, personally; if a partnership, by a general partner; if a corporation, by an officer; for an unincorporated association, by a member who is an officer; if a governmental entity, by such duly elected or appointed official as is competent under the laws of the particular jurisdiction. Counsel may sign the application for his or her client, but only in cases of the applicant's disability or absence from the United States. If the application is filed electronically, the signature will consist of the electronic equivalent of the typed name of the individual. See Report and Order in MM Docket No. 98-43, 13 FCC Rcd 23,056, 23,064 (1998).

The name of the applicant must be stated exactly in Item 1. If the applicant is a corporation, the applicant should list the exact corporate name; if a partnership, the name under which the partnership does business; if an unincorporated association, the name of an executive officer, his/her office, and the name of the association; and, if an individual applicant, the person's full legal name. FCC Registration Number (FRN). To comply with the Debt Collection Improvement Act of 1996, the applicant must enter its FRN number, a ten-digit unique entity identifier for anyone doing business with the Commission. The FRN can be obtained through the FCC webpage at http://www.fcc.gov or by manually submitting FCC Form 160. FCC Form 160 is available for downloading from http://www.fcc.gov/formpage. html or by calling 1-800-418-3676. Questions concerning the FCC Registration Number can be directed to the Commission's Registration System help desk at 1-877http://[email protected] or by calling 480-3201. Facility ID Number. Radio and TV Facility ID Numbers can be obtained at the FCC's Internet Website at www.fcc.gov/mmb. Once at this website, scroll down and select CDBS Public Access. You can also obtain your facility ID number by calling: Radio (202) 418-2700, TV (202) 418-1600. Further, the Facility ID Number is now included on all Radio and TV authorizations and postcards. B. Item 2: Contact Representative. If the applicant is represented by a third party (for example, legal counsel), that person's name, firm or company, and telephone/electronic mail address may be specified in Item 2. C. Item 3: Fees. The Commission is statutorily required to collect charges for certain regulatory services to the public. Generally, applicants seeking authority to construct a new broadcast station or modify an outstanding authorization are required to submit a fee with the filing of FCC Form 350. Government entities, however, are exempt from this fee requirement. Exempt entities include possessions, states, cities, counties, towns, villages, municipal organizations, and political organizations or subparts thereof governed by elected or appointed officials exercising sovereign direction over communities or governmental programs. Also exempt are full-service noncommercial educational radio and TV broadcast licensees and permittees, provided that the proposed facility will be operated noncommercially. See 47 C.F.R. Section 1.1114. When filing a fee-exempt application, an applicant must complete Item 3 and provide an explanation as appropriate. Applications NOT subject to a fee may be hand-delivered

J.

INSTRUCTIONS INFORMATION

FOR

SECTION

I:

GENERAL

A. Item 1: Applicant Name. Applicants should use only those state abbreviations approved by the U.S. Postal Service.

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or mailed to the FCC at its Washington, D.C. offices. See 47 C.F.R. Section 0.401(a). Fee-exempt applications should not be sent to the Mellon Bank Lockbox; so doing will result in a delay in processing the application. The Commission's fee collection program utilizes a U.S. Treasury lockbox bank for maximum efficiency of collection and processing. Prior to the institution of electronic filing procedures, all FCC Form 350 applications requiring the remittance of a fee, or for which a waiver or deferral from the fee requirement is requested, must be submitted to the appropriate post office box address. See 47 C.F.R. Section 0.401(b). A listing of the required fee and the address to which FCC Form 350 should be mailed or otherwise delivered are also set forth in the "Mass Media Services Fee Filing Guide." This document can be obtained either by writing to the Commission's Form Distribution Center, 9300 E. Hampton Drive, Capital Heights, Maryland 20743, or by calling 1-800-418-FORM and leaving a request on the answering machine provided for this purpose. See also 47 C.F.R. Section 1.1104. The Fee Filing Guide also contains a list of the Fee Type Codes needed to complete this application. Payment of any required fee must be made by check, bank draft, money order, or credit card. If payment is made by check, bank draft, or money order, the remittance must be denominated in U.S. dollars, drawn upon a U.S. institution, and made payable to the Federal Communications Commission. No postdated, altered, or third-party checks will be accepted. DO NOT SEND CASH. Additionally, checks dated six months or older will not be accepted. Procedures for payment of application fees when applications are filed electronically can be found by clicking on the CDBS link to the Electronic Filing introductory page on the Mass Media Bureau's Home Page Website at www.fcc.gov/mmb. Payment of application fees may also be made by Electronic Payment prior to the institution of electronic filing, provided that prior approval has been obtained from the Commission. Applicants interested in this option must first contact the Billings and Collections Branch at (202) 418-1995 to make the necessary arrangements. Applicants hand-delivering FCC Forms 350 may receive dated receipt copies by presenting copies of the applications to the acceptance clerk at the time of delivery. For mailedin applications, a "return copy" of the application should be furnished and clearly marked as a "return copy." The applicant should attach this copy to a stamped, selfaddressed envelope. Only one piece of paper per application will be stamped for receipt purposes.

For further information regarding the applicability of a fee, the amount of the fee, or the payment of the fee, applicants should consult the "Mass Media Services Fee Filing Guide."

INSTRUCTIONS INFORMATION

FOR

SECTION

II:

LEGAL

A. Item 1: Certification. Each applicant is responsible for the information that the application instructions convey. As a key element in the Commission's streamlined licensing process, a certification that these materials have been reviewed and that each question response is based on the applicant's review is required. B. Item 2: Permit Conditions. This question requires the applicant to certify that all terms, conditions, and obligations set forth in the underlying construction permit have been fully met. Each Applicant should review its underlying construction permit carefully prior to making its certification to confirm that the facility was constructed exactly in accordance with the permit. If any such term, condition, or obligation has not been fulfilled, the applicant should respond "No" to Section II, Item 2 and provide an appropriate explanatory exhibit. See 47 C.F.R. Section 74.1251. C. Item 3: Changed Circumstances. This question requires the applicant to certify that all information provided in the underlying construction permit application remains correct. If any circumstance has arisen which would cause any statement or representation contained in the construction permit application to be incorrect, the applicant should respond "No" to Section II, Item 3 and provide an appropriate explanatory exhibit. D. Item 4: Programming. An FM translator operator proposing to rebroadcast the signal of a primary station which it does not own must obtain written permission of that station prior to retransmission of that signal. See 47 C.F.R. Section 74.1284. Section II, Item 4 requires the applicant to certify that such written authority has been received. FM translator applicants proposing to rebroadcast the signal of stations that they own, as well as applicants for FM booster stations, should mark the box labelled "Yes." E. Item 5: Station Ready for Operation. This question requires the applicant to certify that the authorized facility is in satisfactory operating condition and ready for regular operation. See 47 C.F.R Section 73.3598(e). Partially constructed facilities, or facilities that are less than authorized in the underlying construction permit, are not sufficient.

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F.

Item 6: Station Identification. FM translator stations are required to broadcast station identification announcements. This can be done in one of two ways. First, the translator station can arrange with the primary station whose signal is rebroadcast to identify the translator station by call sign and location. If the translator station utilizes this method of station identification, there must be three announcements each day: one between 7 a.m. and 9 a.m., one between 12:55 p.m. and 1:05 p.m., and one between 4 p.m. and 6 p.m. FM translator stations that do not begin broadcasting before 9 a.m. must make their first announcement at the beginning of their broadcast day. Alternatively, the FM translator may transmit its call sign in International Morse Code at least once each hour. See 47 C.F.R. Sections 74.1283 and 73.1201.

adverse finding that has not been reported to the Commission and considered in connection with a prior application would require a "No" response. Where the response to Item 8 is "No," the applicant must provide in an exhibit a full disclosure of the persons and matters involved, including an identification of the court or administrative body and the proceeding (by dates and file numbers), and the disposition of the litigation. Where the requisite information has been earlier disclosed in connection with another pending application, or as required by 47 U.S.C. Section 1.65(c), the applicant need only provide an identification of that previous submission by reference to the file number in the case of an application, the call letters of the station regarding which the application or Section 1.65 information was filed, and the date of filing. The applicant should also fully explain why the adverse finding is not an impediment to a grant of this application. NOTE: As used in this question, the term "party to the application" includes any individual or entity whose ownership or positional interest in the applicant is attributable. An attributable interest is an ownership interest in or relation to an applicant or licensee which will confer on its holder that degree of influence or control over the applicant or licensee sufficient to implicate the Commission's multiple ownership rules. See 47 C.F.R. Section 73.3555, as revised and explained in Review of the Commission's Regulations Governing Attribution of Broadcast and Cable/MDS Interests, FCC 99-207, released August 6, 1999. See also, Report and Order in MM Docket No. 83-46, 97 FCC 2d 997 (1984), reconsideration granted in part, 58 RR 2d 604 (1985), further modified on reconsideration, 61 RR 2d 739 (1986). General guidelines are set forth below. INVESTORS AND CREDITORS: Certain interests held by substantial investors in, or creditors of, the applicant may be attributable and the investor reportable as a party to the application, if the interest falls within the Commission's equity/debt plus (EDP) attribution standard. Under the EDP standard, the interest held, aggregating both equity and debt, must exceed 33% of the total asset value (all equity plus all debt) of the applicant, a broadcast station licensee, cable television system, daily newspaper or other media outlet subject to the Commission's broadcast multiple ownership rules AND the interest holder must either also hold an attributable interest in a media outlet in the same market or supply over 15% of the total weekly broadcast programming hours of the station in which the interest is held. For example, the equity interest of an insulated limited partner in a limited partnership applicant would normally not be considered attributable. However, under the EDP standard, that interest would be attributable if the limited partner's interest exceeded 33% of the applicant's total asset value AND the limited partner also held a 5%

G. Items 7 and 8: Character Issues/Adverse Findings. Item 7 requires the applicant to certify that neither it nor any party to the application has had any interest in or connection with an application that was or is the subject of unresolved character issues. An applicant must disclose in response to Item 8 whether the applicant or any party to the application has been the subject of a final adverse finding with respect to certain relevant non-broadcast matters. The Commission's character policies and litigation reporting requirements for broadcast applicants focus on misconduct which violates the Communications Act or a Commission rule or policy and on certain specified non-FCC misconduct. In responding to Items 7 and 8, applicants should review the Commission's character qualifications policies, which are fully set forth in Character Qualifications, 102 FCC 2d 1179 (1985), reconsideration denied, 1 FCC Rcd 421 (1986), as modified, 5 FCC Rcd 3252 (1990) and 7 FCC Rcd 6564 (1992). Where the response to Item 7 is "No," the applicant must submit an exhibit that includes an identification of the party having had the interest, the call letters and location of the station or file number of the application or docket, and a description of the nature of the interest or connection, including relevant dates. The applicant should also fully explain why the unresolved character issue is not an impediment to a grant of this application. In responding to Item 8, the applicant should consider any relevant adverse finding that occurred within the past ten years. Where that adverse finding was fully disclosed to the Commission in an application filed on behalf of this station or in another broadcast station application and the Commission, by specific ruling or by subsequent grant of the application, found the adverse finding not to be disqualifying, it need not be reported again and the applicant may respond "Yes" to this item. However, an

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voting interest in a radio or television station licensee in the same market. INDIVIDUAL APPLICANT: The natural person seeking to hold in his or her own right the authorization specified in this application is a party to the application. PARTNERSHIP APPLICANT: Each partner, including all limited partners may be parties to the application. However, a limited partner in a limited partnership is not considered a party to the application IF the limited partner is not materially involved, directly or indirectly, in the management or operation of the media-related activities of the partnership. Sufficient insulation of a limited partner for purposes of this certification would be assured if the limited partnership arrangement: (1) specifies that any exempt limited partner (if not a natural person, its directors, officers, partners, etc.) cannot act as an employee of the limited partnership if his or her functions, directly or indirectly, relate to the media enterprises of the company; bars any exempt limited partner from serving, in any material capacity, as an independent contractor or agent with respect to the partnership's media enterprises; restricts any exempted limited partner from communicating with the licensee or the general partner on matters pertaining to the day-to-day operations of its business; empowers the general partner to veto any admissions of additional general partners admitted by vote of the exempt limited partners; prohibits any exempt limited partner from voting on the removal of a general partner or limits this right to situations where the general partner is subject to bankruptcy proceedings, as described in Sections 402 (4)-(5) of the Revised Uniform Limited Partnership Act, is adjudicated incompetent by a court of competent jurisdiction, or is removed for cause, as determined by an independent party; bars any exempt limited partner from performing any services to the limited partnership materially relating to its media activities, with the exception of making loans to, or acting as a surety for, the business; and states, in express terms, that any exempt limited partner is prohibited from becoming actively involved in the management or operation of the media businesses of the partnership.

Notwithstanding conformance of the partnership agreement to these criteria, however, if the applicant has actual knowledge of a material involvement of a limited partner in the management or operation of the media-related businesses of the partnership, the limited partner will be considered as a party to this application. LIMITED LIABILITY COMPANY APPLICANT: The Commission treats a LLC as a limited partnership, each of whose members is considered to be a party to the application. However, where a LLC member is insulated in the manner specified above with respect to a limited partnership and where the relevant state statute authorizing the LLC permits a LLC member to insulate itself in accordance with the Commission's criteria, that LLC member is not considered a party to the application. CORPORATE APPLICANT: Each officer, director and owner of stock accounting for 5% or more of the issued and outstanding voting stock of the applicant is considered a party to the application. Where the 5% stock owner is itself a corporation, each of its stockholders, directors and "executive" officers (president, vice-president, secretary, treasurer or their equivalents) is considered a party to this application UNLESS the applicant submits as an exhibit a statement establishing that an individual director or officer will not exercise authority or influence in areas that will affect the applicant or the station. In this statement, the applicant should identify the individual by name and title, describe the individual's duties and responsibilities, and explain the manner in which such individual is insulated from the corporate applicant and should not be attributed an interest in the corporate applicant or considered a party to this application. In addition, a person or entity holding an ownership interest in the corporate stockholder of the applicant is considered a party to this application ONLY IF that interest, when multiplied by the corporate stockholder's interest in the applicant, would account for 5% or more of the issued and outstanding voting stock of the applicant. For example, where Corporation X owns stock accounting for 25% of the applicant's votes, only Corporation X shareholders holding 20 percent or more of the issued and outstanding voting stock of Corporation X have a 5% or more indirect interest in the applicant (.25 x .20 = .05) and, therefore, are considered parties to this application. In applying the multiplier, any entity holding more than 50% of its subsidiary will be considered a 100% owner. Where the 5% stock owner is a partnership, each general partner and any limited partner that is not insulated, regardless of the partnership interest, is considered a party to the application. Stock subject to stockholder cooperative voting agreements accounting for 5% or more of the votes in a corporate applicant will be treated as if held by a single entity and any stockholder holding 5% or more of the stock in that block is

(2)

(3)

(4)

(5)

(6)

(7)

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considered a party to this application. An investment company, insurance company or trust department of a bank is not considered a party to this application, IF its aggregated holding accounts for less than 20% of the outstanding votes in the applicant AND IF: (1) such entity exercises no influence or control over the corporation, directly or indirectly; and such entity has no representatives among the officers and directors of the corporation.

completed if the engineering portion of the application has been prepared by the applicant. In that event, the applicant's certification on Page 3 of FCC Form 350 will encompass both the legal and engineering sections of the application. B. Notification Requirements. All applicants must comply with the requirements of 47 C.F.R. Section 73.1030. Specifically, applicants must notify United States Government radio astronomy installations, radio receiving installations, and FCC monitoring stations of the proposed facility and its possible impact on their operations. The Commission need not be informed of the date of such notification. C. Tech Box: The applicant must accurately specify the information requested in Items 1 through 3 of the Tech Box. Conflicting data found elsewhere in the application will be disregarded. All items must be completed. The response "on file" is not acceptable. The response "not applicable" is not acceptable unless otherwise noted below. D. Item 1: Channel. The proposed channel must be between 201 and 300. See 47 C.F.R. Section 73.201. E. Item 2: Effective Radiated Power. The effective radiated power must be entered in kilowatts, and rounded pursuant to 47 C.F.R. Section 73.212. F. Item 3: Transmitter Power Output. The transmitter power output (TPO) must be specified in kilowatts, and rounded pursuant to 47 C.F.R. Section 73.212.

(2)

ANY OTHER APPLICANT: Each executive officer, member of the governing board and owner or holder of 5% or more of the votes in the applicant is considered a party to the application. H. Item 9: Anti-Drug Abuse Act Certification. This question requires the applicant to certify that neither it nor any party to the application is subject to denial of federal benefits pursuant to the Anti-Drug Abuse Act of 1988, 21 U.S.C. Section 862. Section 5301 of the Anti-Drug Abuse Act of 1988 provides federal and state court judges the discretion to deny federal benefits to individuals convicted of offenses consisting of the distribution or possession of controlled substances. Federal benefits within the scope of the statute include FCC authorizations. A "Yes" response to Item 9 constitutes a certification that neither the applicant nor any party to this application has been convicted of such an offense or, if it has, it is not ineligible to receive the authorization sought by this application because of Section 5301. NOTE: With respect to this question, the term "party to the application" includes if the applicant is an individual, that individual; if the applicant is a corporation or unincorporated association, all officers, directors, or persons holding 5 percent or more of the outstanding stock or shares (voting and/or non-voting) of the applicant; all members if a membership association; and if the applicant is a partnership, all general partners and all limited partners, including both insulated and non-insulated limited partners, holding a 5 percent or more interest in the partnership.

G. Item 4: Constructed Facility. The applicant must certify that the facility was constructed as authorized in the underlying construction permit. If there are any differences between the facilities constructed compared with those authorized in the construction permit, the applicant may need to seek approval for the change on FCC Form 349. See 47 C.F.R. Section 73.1251. H. Item 5: Special Operating Conditions. The special operating conditions are located on the final pages of the construction permit. Attach exhibits, if required, to document compliance with the special operating conditions. NOTE: SPECIAL OPERATING CONDITIONS MAY PROHIBIT AUTOMATIC PROGRAM TEST AUTHORITY. Automatic Program Test Authority: The permittee of an FM Translator or Booster station may begin program tests upon filing FCC Form 350 with the FCC. See 47 C.F.R. Section 74.14. This provision does not apply if the underlying construction permit contains a special operating condition prohibiting automatic program test authority.

INSTRUCTIONS FOR SECTION III: PREPARER'S CERTIFICATION AND ENGINEERING DATA A. Preparer's Certification. When someone other than the applicant has prepared the engineering section of FCC Form 350, Section III requires that person to certify, to the best of his/her knowledge and belief, the veracity of the technical data supplied. The Section III preparer's certification on Page 3 of FCC Form 350 need not be

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I.

Item 6: Transmitter Power Output. The applicant must certify that the transmitter power output (TPO) produces the authorized effective radiated power. The TPO to produce the authorized effective radiated power is calculated as follows: TPO equals Effective Radiated Power

(Antenna power gain) x (Transmission/System Efficiency) Applicants should remember to change percent values to decimal form before calculating TPO. For example, 86% becomes 0.86. J. Item 7: Directional antenna. The applicant must certify that the facility does not use a directional antenna, or in the case of a directional antenna facility, the applicant must certify that the antenna was mounted in accordance with the specific instructions provided by the antenna manufacturer, and is oriented in the authorized direction. See Section 74.1235(i).

FCC NOTICE REQUIRED BY THE PAPERWORK REDUCTION ACT We have estimated that each response to this collection of information will take 1 hour. Our estimate includes the time to read the instructions, look through existing records, gather and maintain the required data, and actually complete and review the form or response. If you have any comments on this burden estimate, or on how we can improve the collection and reduce the burden it causes you, please e-mail them to [email protected] or send them to the Federal Communications Commission, AMDPERM, Paperwork Reduction Project (3060-0404), Washington, DC 20554. Please DO NOT SEND COMPLETED APPLICATIONS TO THIS ADDRESS. Remember - you are not required to respond to a collection of information sponsored by the Federal government, and the government may not conduct or sponsor this collection, unless it displays a currently valid OMB control number of if we fail to provide you with this notice. This collection has been assigned an OMB control number of 3060-0404. THE FOREGOING NOTICE IS REQUIRED BY THE PAPERWORK REDUCTION ACT OF 1995, P.L. 104-13, OCTOBER 1, 1995, 44 U.S.C. Section 3507.

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Federal Communications Commission Washington, D. C 20554

Approved by OMB 3060-0404

FCC 350
APPLICATION FOR AN FM TRANSLATOR OR FM BOOSTER STATION LICENSE
Section I - General Information 1.
Legal Name of the Applicant Mailing Address City Telephone Number (include area code) FCC Registration Number Call Sign

FOR FCC USE ONLY

FOR COMMISSION USE ONLY FILE NO.

State or Country (if foreign address) E-Mail Address (if available) Facility Identifier

ZIP Code

2.

Contact Representative (if other than licensee/permittee) Mailing Address City Telephone Number (include area code)

Firm or Company Name

State or Country (if foreign address) E-Mail Address (if available)

ZIP Code

3.

If this application has been submitted without a fee, indicate reason for fee exemption (see 47 C.F.R. Section 1.1114): Governmental Entity Noncommercial Educational Licensee Other

4.

Facility Information:
a. b.

FM Translator

FM Booster

Community or communities being served:
Community(ies) State

5.

Purpose of Application: Cover construction permit (list original construction permit file number -- starts with the prefix BPFT or BPFTB): Modify an authorized license (list license file number -- starts with the prefix BLFT, BMLFT, BLFTB, or BMLFTB): Amend a pending application If an amendment, submit as an Exhibit a listing by Section and Question Number of the portions of the pending application that are being revised.
Exhibit No.

FCC Form 350 April 2001

NOTE: In addition to the information called for in this section, an explanatory exhibit providing full particulars must be submitted for each question for which a ''No'' response is provided. See General Instruction I. Section 11 - Legal
1.

Certification. Applicant certifies that it has answered each question in this application based on its review of the application instructions and worksheets. Applicant further certifies that where it has made an affirmative certification below, this certification constitutes its representation that the application satisfies each of the pertinent standards and criteria set forth in the application instructions and worksheets. Conditions. Licensee/Permittee certifies that all terms, conditions, and obligations set forth in the underlying construction permit have been fully met.

Yes

No

2.

Yes

No

See Explanation in Exhibit No.

3.

Changed Circumstances. Licensee/Permittee certifies that, apart from changes already reported, no cause or circumstance has arisen since the grant of the underlying construction permit which would cause any statement or representation contained in the construction permit application to be incorrect now. Programming. The applicant is the licensee of the primary station or the applicant certifies that written authority has been obtained from the licensee of the primary station whose programming is to be retransmitted. Station ready for operation. The applicant certifies that the station is now in satisfactory operating condition and ready for regular operation. Station identification. The applicant certifies that it will comply with applicable station identification rules. See 47 C.F.R. Sections 73.1201 and 74.1283. Character Issues. Applicant certifies that neither applicant nor any party to the application has or has had any interest in, or connection with:
a.

Yes

No

See Explanation in Exhibit No.

4.

Yes

No

See Explanation in Exhibit No.

5.

Yes

No

See Explanation in Exhibit No.

6.

Yes

No

See Explanation in Exhibit No.

7.

Yes

No

See Explanation in Exhibit No.

b. 8.

any broadcast application in any proceeding where character issues were left unresolved or were resolved adversely against the applicant or party to the application; or any pending broadcast application in which character issues have been raised.
Yes No See Explanation in Exhibit No.

Adverse Findings. Applicant certifies that, with respect to the applicant and any party to the application, no adverse finding has been made, nor has an adverse final action been taken by any court or administrative body in a civil or criminal proceeding brought under the provisions of any law related to the following: any felony; mass media-related antitrust or unfair competition; fraudulent statements to another governmental unit; or discrimination. Anti-Drug Abuse Act Certification. Applicant certifies that neither applicant nor any party to the application is subject to denial of federal benefits pursuant to Section 5301 of the Anti-Drug Abuse Act of 1988, 21 U.S.C. Section 862.

9.

Yes

No

FCC Form 350 (Page 2) April 2001

I certify that the statements in this application are true, complete, and correct to the best of my knowledge and belief, and are made in good faith. I acknowledge that all certifications and attached Exhibits are considered material representations. I hereby waive any claim to the use of any particular frequency as against the regulatory power of the United States because of the previous use of the same, whether by license or otherwise, and request an authorization in accordance with this application. (See Section 304 of the Communications Act of 1934, as amended.)
Typed or Printed Name of Person Signing Typed or Printed Title of Person Signing

Signature

Date

SECTION III PREPARER'S CERTIFICATION I certify that I have prepared Section III (Engineering Data) on behalf of the applicant, and that after such preparation, I have examined and found it to be accurate and true to the best of my knowledge and belief.
Name

Relationship to Applicant (e.g., Consulting Engineer)

Signature Mailing Address

Date

City
Telephone Number (include area code)

State or Country (if foreign address) E-Mail Address (if available)

ZIP Code

WILLFUL FALSE STATEMENTS ON THIS FORM AR-E PUNISHABLE BY FINE AND/OR IMPRISONMENT (U.S. CODE, TITLE 18, SECTION I 00 1), 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 Form 350 (Page 3) April 2001

Section III - Engineering TECHNICAL SPECIFICATIONS Ensure that the specifications below are accurate. Contradicting data found elsewhere in this application will be disregarded. All items must be completed. The response ''on file'' is not acceptable. TECH BOX

1. 2. 3

Channel: Effective Radiated Power: Transmitter Power Output: kW (H) kW kW (V)

NOTE: In addition to the information called for in this section, an explanatory exhibit providing full particulars must be submitted for each question for which a ''No'' response is provided. CERTIFICATION All applicants must complete this section.

4.

Constructed Facility. The facility was constructed as authorized in the underlying construction permit.

Yes

No

See Explanation in Exhibit No.

5.

Special Operating Conditions. The facility was constructed in compliance with all special operating conditions, terrns, and obligations described in the construction permit. An Exhibit may be required. Review the underlying construction permit.

Yes

No

See Explanation in Exhibit No.

Exhibit No.

6.

Transmitter Power Output. The operating transmitter power output produces the authorized effective radiated power.

Yes

No

See Explanation in Exhibit No.

7.

Directional Antenna. The facility does not use a directional antenna or the antenna is mounted in accordance with the specific instructions provided by the antenna manufacturer and is oriented in the proper direction.

Yes

No

See Explanation in Exhibit No.

PREPARER'S CERTIFICATION ON PAGE 3 MUST BE COMPLETED AND SIGNED.

FCC Form 350 (Page 4) April 2001