Federal Communications Commission
Washington, D.C. 20554
Approved by OMB
3060-0906 (November 2008)
FCC 317
FOR FCC USE ONLY
 
ANNUAL DTV ANCILLARY/SUPPLEMENTARY SERVICES REPORT FOR DIGITAL TELEVISION STATIONS

Read INSTRUCTIONS Before Filling Out Form

FOR COMMISSION USE ONLY
FILE NO.

BAFDDT - 20121127AZN
Section I - General Information
1. Legal Name of the Licensee or Permittee
SUMMIT COUNTY
Mailing Address
60 NORTH MAIN
P.O. BOX 128

City
COALVILLE
State or Country (if foreign address)
UT
ZIP Code
84017 -
Telephone Number (include area code)
4353363220
E-Mail Address (if available) 
FCC Registration Number:
0006175699
Facility ID Number
167179
Call Sign 
K21JL-D
2. Contact Representative (if other than Licensee or Permittee)
RON TITCOMB
Firm or Company Name
SUMMIT COUNTY
Telephone Number (include area code)
4356542617
E-Mail Address (if available)
RTICOMB@AOL.COM
3. For the twelve-month period ended September 30th, has the DTV licensee or permittee provided, at any time during the period, an ancillary or supplementary service as defined by 47 C.F.R. Section 73.624?

If "No," complete Question 7 and submit this Report to the Commission.

If "Yes," proceed to Questions 4 through 7.

Yes No
4. Ancillary/Supplementary Services Provided. Briefly describe below the service provided; whether a fee was charged for the provision of such service; and, if so, the amount of gross revenues received therefrom and the amount of DTV bitstream used to provide such service.

[Services Provided]



5. Total amount of gross revenues derived from feeable ancillary or supplementary services: $
6. Has the DTV licensee or permittee remitted to the Commission, through the filing of FCC Form 159, a payment in the amount of 5% of the gross revenues derived from the feeable ancillary or supplementary services? Yes No
N/A
7. Certification. I certify that I have examined this Report and that, to the best of my knowledge and belief, all statements in this Report are true, correct and complete.
Typed or Printed Name of Person Signing
RON TITCOMB
Typed or Printed Title of Person Signing
COUNTY TRANSLATOR TECHNICIAN
Signature
Date
11/27/2012

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