| 1. |
Legal Name of the Applicant
|
Mailing Address
|
City
|
State or Country (if foreign address)
|
Zip Code
- |
Telephone Number (include area code)
|
E-Mail Address (if available)
|
Call Sign
|
Facility ID Number
6463 |
| 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. |
Purpose:
 Notification of Suspension of Operations |
| Notification of Suspension of Operations and Request for Silent STA |
| Request for Silent STA |
| Request to Extend STA |
| Resumption of Operations |
| 4 |
Community of License:
City: State: |
| 5. |
Reason for going silent:
Technical Financing Staffing
Program Source Other |
| 6. |
| Please provide a justification for the request |
|
[Exhibit 4] |
| 7. |
Date Station will go silent: (mm/dd/yyyy)
|
|
| 8. |
| 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. |
|
Yes No |
I hereby certify that the statements in this application are true, complete, and correct to the best of my kowledge and belief, and are made in good faith. I acknowledge that all certifications and attached Exhibits are considered material representations.
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).