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).
FCC NOTICE REQUIRED BY THE PAPERWORK REDUCTION ACT
We have estimated that each response to this collection of information will take 3 hours. Our estimate includes the time to read the
instructions, look through existing records, gather and maintain required data, and actually complete and review the form or
response. If you have any comments on this estimate, or on how we can improve the collection and reduce the burden it causes you,
please write the Federal Communications Commission, AMD-PERM, Paperwork Reduction Project (3060-1115), Washington, D.C. 20554. We will also accept your comments via the Internet if you send them to firstname.lastname@example.org. Remember - you are not required to
respond to a collection of information sponsored by the Federal government, and the government may not conduct or sponsor this
collection, unless it displays a currently valid OMB control number or if we fail to provide you with this notice. This collection has
been assigned an OMB control number of 3060-1115.
THE FOREGOING NOTICE IS REQUIRED BY THE PAPERWORK REDUCTION ACT OF 1995, P.L. 104-13,
OCTOBER 1, 1995, 44 U.S.C. 3507.