Federal Communications Commission
Washington, D.C. 20554
Approved by OMB
3060-0390 (April 2000)
FOR FCC USE ONLY
CODE NO. -
 
BROADCAST STATION ANNUAL EMPLOYMENT REPORT  
SECTION I
Legal Name of the Licensee
Mailing Address

City
State or Country (if foreign address)
Zip Code
-
Telephone Number (include area code)
E-Mail Address (if available)
  Facility ID Number
59526
Call Sign

SECTION II      
A. TYPE OF RESPONDENT:
Commercial Broadcast Station
Radio
TV
Low Power TV
International
Noncommercial Broadcast Station
Educational Radio
Educational TV
 
Headquarters
HQ

B. List call sign and location of all stations whose employees are on this report. This should include commonly owned stations which share one or more employees.

[Stations Locations]



SECTION III
A. PAYROLL PERIOD COVERED BY THIS REPORT (DATE)
B. CHECK APPLICABLE BOX
Fewer than five full-time employees in employment unit during the selected payroll period (Complete page one only and certification statement and return to FCC)
Five or more full-time employees in employment unit during the selected payroll period (Complete all sections of form and certification statement and return to FCC)



SECTION IV CERTIFICATION

This report must be certified, as follows: (a). By licensee, if an individual; (b). By the individual owning the reporting system if individually owned; (c). By a partner, if a partnership (general partner, if a limited partnership); (d). By an officer, if a corporation or an association; or (e). By an attorney of the licensee, in case of physical disability or absence from the United States of the licensee.

WILLFUL FALSE STATEMENTS 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).

I certify to the best of my knowledge, information and belief, all statements contained in this report are true and correct.
Signed
Print Name
Title
Telephone No. ( include area code)
Date
 

SECTION V EMPLOYEE DATA

A. FULL-TIME PAID EMPLOYEE DATA
[Full-Time Paid Employee Data]



B. PART-TIME PAID EMPLOYEE DATA
[Part-Time Paid Employee Data]





Additional Information [Exhibit 1]



Exhibits