Federal Communications Commission
Washington, D.C. 20554
Approved by OMB
3060-0031 (September 2004)
FOR FCC USE ONLY
 
Extension of Consummation

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)
FCC Registration Number:
Call Sign 
Facility ID Number
69816
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:
Consummation Notice
Extension of Consummation
Notification of Non-consummation
4. Consummation for:
Assignment of License and/or Permit
Transfer of Control
5.
Lead Station File Number:      - 
Lead Facility ID:    
6.
(a) I request a ninety (90) day extension of the deadline to consummate the referenced assignment
of license/transfer of control application
Yes   No

(b) This is a second or greater extension of time for consummation request

Yes No
If yes to Item #b, an exhibit is attached which (1) states the reason for the further extension and (2) states that
all the pertinent information included in the application is still current
[Exhibit 1]

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.

Typed or Printed Name of Person Signing
Typed or Printed Title of Person Signing
Signature
Date

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