Federal Communications Commission
Washington, D.C. 20554
Approved by OMB
3060-0017 (June 2002)
FCC 347
FOR FCC USE ONLY
APPLICATION FOR A LOW POWER TV, TV TRANSLATOR OR TV BOOSTER STATION LICENSE

Read INSTRUCTIONS 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
184508
2. Contact Representative (if other than Applicant)

Firm or Company Name

Telephone Number (include area code)

E-Mail Address (if available)

3. If this application has been submitted without a fee, indicate reason for fee exemption (see 47 C.F.R. Section 1.1114):
Governmental Entity Noncommercial Educational Licensee/Permittee Other
N/A (Fee Required)
4.
Facility Information
a. Low Power TV Station TV Translator TV Booster
Digital Low Power TV      Digital TV Translator
b. Community of License:
City: State:
5. Purpose of Application
 Cover construction permit (list original construction permit file number -- starts with the prefix BPTTL, BPTT, BPTVL, BPTTV, BMPTTL, BMPTT, BMPTVL, BMPTTV, BPVB, BPUB, BMPVB or BMPUB): -
 Amend a pending application

If an amendment, submit as an Exhibit a listing by Section and Question Number the portions of the pending application that are being revised.

[Exhibit 1]



NOTE: In addition to the information called for in this section, an explanatory exhibit providing full particulars must be submitted for each question for which a "No" response is provided.

Section II - Legal

1.
Certification.  Licensee/Permittee certifies that it has answered each question in this application based on its review of the application instructions and worksheets. Licensee/Permittee further certifies that where it has made an affirmative certification below, this certification constitutes its representation that the application satisfies each of the pertinent standards and criteria set forth in the application instructions and worksheets.
Yes No
2. Licensee/Permittee certifies that all terms, conditions, and obligations set forth in the underlying construction permit have been fully met.
Yes No
See Explanation in
[Exhibit 2]
3. Licensee/Permittee certifies that, apart from changes already reported, no cause or circumstance has arisen since the grant of the underlying construction permit which would result in any statement or representation contained in the construction permit application to be now incorrect.
Yes No
See Explanation in
[Exhibit 3]
4. Programming. The applicant certifies that it is either the licensee of the primary station whose programming is to be retransmitted or has obtained written authority from the licensee of that station.
Yes No
See Explanation in
[Exhibit 4]
5. Character Issues. Licensee/Permittee certifies that neither licensee/permittee nor any party to the application has or has had any interest in, or connection with:

a. any broadcast application in any proceeding where character issues were left unresolved or were resolved adversely against the applicant or party to the application; or
b. any pending broadcast application in which character issues have been raised.
Yes No


See Explanation in [Exhibit 5]
6. Adverse Findings. Licensee/Permittee certifies that, with respect to the licensee/permittee and any party to the application, no adverse finding has been made, nor has an adverse final action been taken by any court or administrative body in a civil or criminal proceeding brought under the provisions of any law related to the following: any felony; mass media-related antitrust or unfair competition; fraudulent statements to another governmental unit; or discrimination.
Yes No

See Explanation in [Exhibit 6]

7. Anti-Drug Abuse Act Certification. Licensee/Permittee certifies that neither licensee/permittee 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 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. I hereby waive any claim to the use of any particular frequency as against the regulatory power of the United States because of the previous use of the same, whether by license or otherwise, and request an authorization in accordance with this application. (See Section 304 of the Communications Act of 1934, as amended.)
Typed or Printed Name of Person Signing
Typed or Printed Title of Person Signing
Signature
Date



SECTION III - Engineering
TECHNICAL SPECIFICATIONS
Ensure that the specifications below are accurate. Contradicting data found elsewhere in this application will be disregarded. All items must be completed. The response "on file" is not acceptable.
TECH BOX
1. Channel:
2. Frequency Offset (analog stations): No offset Zero offset Plus offset Minus offset
3.
Antenna Location Coordinates: (NAD 27)

Latitude:    
Degrees Minutes Seconds     North     South

Longitude: 
Degrees Minutes Seconds     West     East


4.
Maximum Effective Radiated Power (ERP) (if analog station Toward Radio Horizon):  kW
5.
Maximum ERP in any horizontal and vertical angle (analog stations):  kW

NOTE:    In addition to the information called for in this section, an explanatory exhibit providing full particulars must be submitted for each question for which a "No" response is provided.

CERTIFICATION

All applicants must complete this section.
6.
Constructed Facility.  The facility was constructed as authorized in the underlying construction permit.
Yes No

See Explanation in
[Exhibit 7]

7.
Special Operating Conditions.  The facility was constructed in compliance with all special operating conditions, terms, and obligations described in the construction permit.




An exhibit may be required. Review the underlying construction permit.
Yes No
See Explanation in
[Exhibit 8]


[Exhibit 9]

PREPARER'S CERTIFICATION ON PAGE 4 MUST BE COMPLETED AND SIGNED.





SECTION III - PREPARER'S CERTIFICATION

I certify that I have prepared Section III (Engineering Data) on behalf of the applicant, and that after such preparation, I have examined and found it to be accurate and true to the best of my knowledge and belief.

Name
Relationship to Applicant (e.g., Consulting Engineer)
Signature
Date
Mailing Address

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