Federal Communications Commission
Washington, D.C. 20554
Approved by OMB
3060-0386 (July 2002)
FOR FCC USE ONLY
 
Notification of Suspension of Operations

Read Instructions/FAQ before filling out form

FOR COMMISSION USE ONLY
FILE NO.

Section I - General Information
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
86208
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.

Typed or Printed Name of Person Signing
Typed or Printed Title of Person Signing
Signature
Date (mm/dd/yyyy)

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