Federal Communications Commission
Washington, D.C. 20554
Approved by OMB
3060-0084 (June 2002)
FCC 323-E
FOR FCC USE ONLY
 
Ownership Report For Noncommercial Educational Broadcast Station

Read INSTRUCTIONS Before Filling Out Form

FOR COMMISSION USE ONLY
FILE NO.

-
Section I - General
1. Legal Name of the Licensee/Permittee

Mailing Address

City
State or Country (if foreign address)
ZIP Code
-
Telephone Number (include area code)
E-Mail Address (if available) 
FCC Registration Number:

Call Sign 
Facility ID Number 
70537
2. Contact Representative (if other than Licensee/Permittee)

Firm or Company Name

Mailing Address

City
State or Country (if foreign address)
ZIP Code
-
Telephone Number (include area code)

E-Mail Address (if available)

3. Name of entity, if other than licensee or permittee, for which report is filed

Mailing Address


City
State or Country (if foreign address)
ZIP Code
-
Telephone Number (include area code)
E-Mail Address (if available)



Section II - Ownership Information

4.
All of the information furnished in this Report is accurate as of (Date must comply with 47 C.F.R. Section 73.3615(d), i.e., information must be current within 60 days of filing of this report, when 4(a) below is checked.)

This Report is filed for (check one)
a. Biennial b. Transfer of Control or Assignment of License/Permit c. Other
d. Amendment to pending application


for the following stations:

[Enter Station Information]



5.
List all contracts and other instruments required to be filed by 47 C.F.R. Section 73.3613.   (Only licensees, permittees, or a reporting entity with a majority interest in or that otherwise exercises de facto control over the subject licensee or permittee shall respond.)

[Enter Contract/Instrument Information]



6.
Is the governing board directly or indirectly under the control of another entity?
Yes No
If Yes, is a separate FCC Form 323-E submitted for such entity?
Yes No
 7.
List officers, members of governing board, and holders of 1% or more ownership interest, if any. Use one column for each individual or entity. Attach supplemental pages, if necessary.
[Enter Owner Information]




SECTION III - CERTIFICATION


I certify that I am

(Official Title)


of

(Exact legal title or name of respondent)


and that I have examined this Report and that to the best of my knowledge and belief, all statements in this Report are true, correct and complete.

(Date of certification must be within 60 days of the date shown in Question 4, Section II and in no event prior to that date.)

Signature
Date
Telephone Number of Respondent (Include area code)


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).



Exhibits