1. |
Certification. Applicant certifies that it has answered each question in this application based on its review of the application instructions and worksheets. Applicant 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. |
Parties to the Application. List the applicant and all parties to the application. If other than natural persons, list officers, directors, stockholders with interests of 1% or more, general and limited partners and/or members.
a. |
Name and address of the applicant and, if applicable,
its officers, directors, stockholders with interests of
1% or greater, or partners (if other than individual also
show name, address and citizenship of natural person
authorized to vote the stock). List the applicant first,
officers next, then directors and, thereafter remaining
stockholders and partners. |
b. |
Citizenship.
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c. |
Positional Interest: Officer, director, general partner, limited partner, LLC member, etc.
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d. |
Percentage of votes.
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e. |
Percentage of equity.
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[Enter Parties Information]
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3. |
Character Issues. Applicant certifies that neither applicant 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
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b. |
any pending broadcast application in which character issues have been raised. |
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Yes No
See Explanation in
[Exhibit 2]
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4. |
Adverse Findings. Applicant certifies that, with respect to the applicant and any party to the application, no adverse finding has been made, nor has an adverse final action been taken 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 3]
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5. |
Alien Ownership and Control. Applicant certifies that it complies with the provisions of Section 310 of the Communications Act of 1934, as amended, relating to interests of aliens and foreign governments. |
Yes No
See Explanation in
[Exhibit 4]
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6. |
Program Service Certification. (For Low Power Television Applicants Only) Applicant certifies that this station will offer a broadcast program service. |
Yes No |
7. |
Local Public Notice. (For new station and major change Applicants Only) Applicant certifies that it has or will comply with the public notice requirements of 47 C.F.R. Section 73.3580. |
Yes No |
8. |
Rebroadcast Certification. (For Applicants proposing translator rebroadcasts that are not the licensee of the primary station) Applicant certifies that written authority has been obtained from the licensee of the station whose programs are to be retransmitted. |
Yes No |
9. |
Auction Authorization. If the application is being submitted to obtain a construction permit for which the applicant was the winning bidder in an auction, then the applicant certifies, pursuant to 47 C.F.R. Section 73.5005(a), that it has attached an exhibit containing the information required by 47 C.F.R. Sections 1.2107(d), 1.2110(i), 1.2112(a) and 1.2112(b), if applicable. |
Yes No
N/A |
An exhibit is required unless this question is inapplicable. |
[Exhibit 5] |
10. |
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 |
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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.
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12. |
Out-of-channel Emission Mask: Simple Stringent Full Service |
CERTIFICATION
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13. |
Interference : The proposed facility complies with all of the following applicable rule sections. 47.C.F.R Sections 74.709, 74.793(e), 74.793(f), 74.793(g), 74.793(h), 74.794(b) and 73.1030.
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Yes No
See Explanation in
[Exhibit 12]
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14. |
Environmental Protection Act. The proposed facility is excluded from environmental processing under 47. C.F.R. Section 1.1306 (i.e., The facility will not have a significant environmental impact and complies with the maximum permissible radiofrequency electromagnetic exposure limits for controlled and uncontrolled environments). Unless the applicant can determine RF compliance, an Exhibit is required.
By checking "Yes" above, the applicant also certifies that it, in coordination with other users of the site, will reduce power or cease operation as necessary to protect persons having access to the site, tower or antenna from radiofrequency electromagnetic exposure in excess of FCC guidelines. |
Yes No
See Explanation in
[Exhibit 13]
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15. |
Channels 52-59. If the proposed channel is within channels 52-59, the applicant certifies compliance with the following requirements, as applicable:
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The applicant is applying for a digital companion channel for which no suitable channel from channel 2-51 is available. |
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Pursuant to Section 74.786(d), the applicant has notified, within 30 days of filing this application, all commercial wireless licenses of the spectrum comprising the proposed TV channel and the first adjacent channels thereto, for which the proposed digital LPTV or TV translator antenna site lies inside the licensed geographic boundaries of the wireless licensees or within 75 miles and 50 miles, respectively, of the geographic boundaries of co-channel and adjacent-channel wireless licensees. |
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16. |
Channels 60-69. If the proposed channel is within channels 60-69, the applicant certifies compliance with the following requirements, as applicable:
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Pursuant to Section 74.786(e), the applicant has notified, within 30 days of filing this application , all commercial wireless licenses of the spectrum comprising the proposed TV channel and the first adjacent channels thereto, for which the proposed digital LPTV or TV translator antenna site lies inside the licensed geographic boundaries of the wireless licensees or within 75 miles and 50 miles, respectively, of the geographic boundaries of co-channel and adjacent-channel wireless licensees. |
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Pursuant to Section 74.786(e), the applicant proposing operation on channel 63, 64, 68 and 69 ("public safety channels") has secured a coordinated spectrum use agreements(s) with 700 MHz public safety regional planning committee(s) and state administrator(s) of the region(s) and state(s) within which the antenna site of the digital LPTV or TV translator station is proposed to locate, and those adjoining regions and states with boundaries within 75 miles of the proposed station location. |
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Pursuant to Section 74.786(e), the applicant for a channel adjacent to channel 63, 64, 68 or 69 has notified, within 30 days of filing this application, the 700 MHz public safety regional planning committee(s) and state administrator(s) of the region and state containing the proposed digital LPTV or TV translator antenna site and regions and states whose geographic boundaries lie within 50 miles of the proposed LPTV or TV translator antenna site. |
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PREPARERS CERTIFICATION ON PAGE 3 MUST BE COMPLETED AND SIGNED.
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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).