TV Broadcaster Relocation Fund Reimbursement Application

Applicant Information

Applicant Name, Type, and Contact Information

Applicant	Address	Phone	Email	Applicant Type
PRIEST LAKE TRANSLATOR DISTRICT Doing Business As: PRIEST LAKE TRANSLATOR DISTRICT	PO Box 53 COOLIN, ID 83821 United States	+1 (208) 443-2492	ayer.larry2@gmail.com	Government Entity

Applicant

Address

Phone

Applicant Type

PRIEST LAKE TRANSLATOR DISTRICT

Doing Business As: PRIEST LAKE TRANSLATOR DISTRICT

PO Box 53

COOLIN, ID 83821

United States

+1 (208) 443-2492

ayer.larry2@gmail.com

Government Entity

Reimbursement Contact Information

Reimbursement Contact Name and Information

Applicant	Address	Phone	Email
[Confidential]

Preparer Contact Information

Preparer Contact Name and Information

Applicant	Address	Phone	Email
The Preparer is same as the reimbursement contact.

Broadcaster Information and Transition Plan

Question	Response
Will the station be sharing equipment with another broadcast television station or stations (e.g., a shared antenna, co-location on a tower, use of the same transmitter room, multiple transmitters feeding a combiner, etc.)? If yes, enter the facility ID's of the other stations and click 'prefill' to download those stations' licensing information.	Yes
Briefly describe transition plan	Antenna for this facility will be on the same tower structure (utility pole) as are the antennas for K31DS-D and K32OA-D, both also sharing the same communications building, electricity, etc. and are licensed by the Priest Lake Translator District.

Transmitters

Section	Question	Response
Transmitter Related Expenses	Do you have transmitter related expenses?	Yes

Primary Transmitter

Existing Transmitter Information

Section	Question	Response
Existing Transmitter Description	Type of change	Purchase New
	Use	Primary (Main)
	Ownership	Owned
	Is this transmitter currently shared with another station?	No
	Is this transmitter currently in operating condition?	Yes
Existing Transmitter Manufacturer and Type	Manufacturer
	Model	TADU-40
	Year	2009
	Type	Solid State
	Solid State Cooling	Air Cooled
	Solid State Power Capacity	40.0 W

Primary Transmitter

New Transmitter Costs

Section	Question	Response
New Transmitter	Use	Primary (Main)
	Change Type	Purchase New
	Is this a request for upgraded equipment?	No
	Manufacturer
	Model	UAXTE-50
	Transmitter Type	Solid State
	Solid State Cooling	Air Cooled
	Solid State Power capacity	50.0 W
	Justification for New Transmitter	Old transmitter on former channel-40, with lower power output; new repack channel-33 and higher power was required, and justified the purchase.

Primary Transmitter

Other Transmitter Costs

Section	Question	Response
Other Transmitter Costs
Other Transmitter Costs	Does the transmitter installation require a Transmitter Building Site Survey/Installation?	No
Electrical Service	Service Entrance (3 phases 800A 208V)	No
	Switchgear (industrial 800 amp)	No
	Transformer (480V)	No
	Rigid Conduit and Wiring	No
	Other Electrical Service	Yes
	Description	A new 120/240-volt, 100-amp service panel was installed, with additional service outlets for all equipment & 240-volt service for new air conditioner.
HVAC Service	Does the replacement transmitter require HVAC Service?	Yes
	Type	Heating and Cooling
	Size	Other
	Other Size	1 tons
Transmitter Building Addition/Modification or Leasehold Improvement	Does the Transmitter Building require an addition, modification, other leashold improvement?	No

Primary Transmitter

Other Transmitter Cost Not Listed

Name	Description
GatesAir, Inc	Provided new UAXTE-50 transmitter, critical ATSC mask filter, and Sencore #MRD-2600 rcvr/transcoder.

Antennas

Section	Question	Response
Antenna Related Expenses	Do you have antenna related expenses?	Yes

Primary Antenna

Existing Antenna Information

Section	Question	Response
Existing Antenna Description	Type of change	Purchase New
	Antenna Use	Primary (Main)
	Ownership	Owned
	Is the existing antenna shared with another station or stations?	No
	Is the existing antenna directional?	Yes
	Is antenna in operating condition?	Yes
	Is antenna located on or in close proximity to an antenna farm?	No
Existing Antenna Manufacturer and Type
	Mounting	Side Mount
	Antenna position in stack	Bottom
	Polarization	Horizontal
	Type	Other
	Other Antenna Type	Panel
	ERP:	75.0 W
	Manufacturer
	Model	4DR-4S
	Year	1993

Primary Antenna

New Antenna Costs

Section	Question	Response
New Antenna Description	Use	Primary (Main)
	Change Type	Purchase New
	Ownership	Owned
	Is antenna shared?	No
	Is antenna directional?	Yes
	Will antenna be located on or in close proximity to an antenna farm?	No
New Antenna Manufacturer and Types
	Mounting	Side Mount
	Antenna position in stack	Bottom
	Polarization	Horizontal
	Type	Broadband Panel
	Number of Stations Supported	1
	Number of Panels/Bays	2
	Lower Limit	584.00 MHz
	Upper Limit	590.00 MHz
	Design power capacity in use	10.0 %
	ERP:	100.0 W
	Manufacturer
	Model	SCA-4DR4S2944
	Year	2019
	Justification for New Antenna	Former antenna was cut to ch-51, and too far away from the new channel-33 to reutilize for this channel change

Primary Antenna

Other Antenna Costs

Section	Question	Response
Elbow Complex	Do you require the separate purchase of the Elbow Complex?	No
Side Mount Brackets	Do you require the separate purchase of side mount brackets for a high power antenna?	No
Pattern Scatter Analysis	Do you require separate purchase of pattern scatter analysis for a side mount high or medium power antenna?	No
Sweep Test	Do you require the sweep testing of transmission line and antenna?	No
Power Dividers	Does the panel antenna require power dividers?	Yes
Power Dividers	Number of Power Dividers	1
Cable Harness	Does the panel antenna require cable harness?	Yes
Cable Harness	Number of Cable Harnesses	2

Primary Antenna

Other Antenna Cost Not Listed

Information not provided.

Transmission Line

Section	Question	Response
Transmission Line Related Expenses	Do you have transmission line related expenses?	No

Tower Equipment And Rigging Costs

Section	Question	Response
Tower Equipment or Rigging Costs Changes	Do you have tower equipment or rigging costs changes?	Yes

Primary Tower

Existing Tower

Section	Question	Response
Existing Tower Description	Type of change	Move Equipment
	Tower Use	Primary (Main)
	Ownership	Owned
	Is this tower consider Complex?	No
	Is this tower currently shared with any other stations?	Yes
	One or more FM, AM or TV radio broadcaster(s)	No
	Others Types of Users	Yes
	Is tower documented for structural analysis?	Unknown
	Is tower compliant with Rev G?	Unknown
Existing Tower Structure Registration	Do you have a tower registration number?	Yes
Existing Tower Structure Registration	ASR Number	1293841
Coordinates (NAD83)	Latitude (NAD83)	48° 31' 51.2" N-
	Longitude (NAD83)	116° 49' 01.4" W-
	Overall Structure Height	49.87 feet
	Support Structure Height	49.87 feet
	Ground Elevation Above Mean Sea Level (AMSL)	3158.10 feet
	Structure Type	GTOWER - Guyed Structure Used for Communication Purposes
	Tower Owner	Priest Lake Translator District
	Date Constructed	01/01/1991

Other Types of Users

Users
K31DS-D
K32OA-D

Primary Tower

Tower Rigging Costs

Section	Question	Response
Tower Rigging Costs	Complex Tower	N/A
Helicopter Services Required	Are helicopter services required?	No

Primary Tower

Other Tower Expenses Not Listed

Name	Description
Replace antennas	Air Pipe 2-man crew to remove old channel-51 antennas & power divider, and replace with new channel 33 antennas & power divider

Outside Professional Services Costs

Section	Question	Response
Outside Project Management Services	Do you require outside project management services?	No
Outside RF consulting Engineering Services	Perform engineering study for displacement application	Yes
	Prepare engineering section of Form FCC Construction Permit Application	Yes
	For Auxiliary Facility	No
	For Main Facility	Yes
	Prepare engineering section of Form FCC License to Cover Application	Yes
	For Auxiliary Facility	No
	For Main Facility	Yes
	Prepare request for Special Temporary Authority	No
	Prepare Form 601	No
Attorney and Other Outside Consulting Services	Prepare and file Form FCC Construction Permit Application	No
	Prepare and file Form FCC License to Cover Application	No
	Prepare request for Special Temporary Authority	No
	Negotiation of Lease and other Matter for Shared Locations	No
	Prepare or Review FCC Form 399 for Reimbursement	Yes
	Form 399 assistance or other program management costs	Yes
RF Field Engineering Services	Comprehensive coverage verification via field study	No
	RF exposure measurements	No
	Additional Field Engineering Service	No

Outside Professional Services Costs

Other Professional Services Expenses Not Listed

Name	Description
Barnett Professional Services	Assist with initial start-up of new transmitter, plus programming the menu to achieve proper power output and all other operational parameters; Barnett's invoice total is divided 50/50 with station K32OA-D, with the same equipment & in the same comm bldg.
KSPS, PBS-Spokane,WA	Provided consulting engineering assistance in resolving input channel interference to Sencore rcvr/ transcoder.

Other Expenses

Section	Question	Response
AM Pattern Disturbance	Is an Impact Study needed?	No
AM Pattern Disturbance	Is Remediation needed?	No
Permit and Filing Costs	FCC Construction Permit Major Change	No
	FCC Construction Permit Minor Change	No
	FCC License to Cover Application	No
	FCC Special Temporary Authority Application	No
Other Miscellaneous Expenses	Does this relocation require paying Disposal Costs (for equipment and other waste, net of any salvage value)?	No
	Does this relocation require Equipment Delivery or Handling Charges not otherwise included in individual item costs?	No
	Does this relocation require Equipment Storage?	No
Point to Point Microwave (STL/ICR)	Frequency Coordination for Unidirection System	No
	Frequency Coordination for Bi-Direction System	No
	New Point to Point Microwave System	No

Other Expenses

Other Expenses Not Listed

Information not provided.

Cost Information

Transmitters

Where no predetermined cost estimate is available, any estimate provided will also become the predetermined cost (displayed in italics).

Description	Predetermined Cost Estimate	Estimated Cost	Estimated Cost Justification	Actual Cost	Actual Cost Justification
Sub-total	$27,416.90	$17,216.90	N/A	$17,216.90	N/A
Total for all systems	$99,485.34	$25,613.34	N/A	$25,613.34	N/A
Primary Transmitter UAXTE-50	$27,416.90	$17,216.90		$17,216.90
GatesAir, Inc	$14,245.70	$14,245.70	N/A	$14,245.70	N/A
Other -- HVAC Service Type: H Size:1 (Other)	$1,900.00	$1,900.00	N/A	$1,900.00	N/A
Other Electrical Service: A new 120/240-volt, 100-amp service panel was installed, with additional service outlets for all equipment & 240-volt service for new air conditioner.	$1,071.20	$1,071.20	Eagle Electric, a licensed contractor, installed a new 100-amp electrical panel and additional 20-amp outlets in the communications bldg., and connected a new 240-volt service to the air conditioning system; all new wiring in armored cable.	$1,071.20	N/A
UHF - Air Cooled Solid State Transmitter 5 - 50 Watts	$10,200.00	$0.00	N/A	$0.00	N/A

Components

Actual Information Description	File Name
GatesAir, Inc	Component Description: GatesAir, providing new transmitter, mask filter & input channel receiver/transcoder. The amount of reimbursement requested is one-half of the invoice total; the other half is being requested for station K32OA-D in a separate application. Amount: $14,245.70
Other -- HVAC Service Type: H Size:1 (Other)	Component Description: Heating Invoice total is being split 50/50 with K320A-D Amount: $1,900.00
Other Electrical Service: A new 120/240-volt, 100-amp service panel was installed, with additional service outlets for all equipment & 240-volt service for new air conditioner.	Component Description: Cost is being shared 50/50 with station K32OA-D since both operate from the same comm. bldg. & share the electrical system upgrades. Amount: $1,071.20
UHF - Air Cooled Solid State Transmitter 5 - 50 Watts	Information not provided.

Cost Information

Antennas

Where no predetermined cost estimate is available, any estimate provided will also become the predetermined cost (displayed in italics).

Description	Predetermined Cost Estimate	Estimated Cost	Estimated Cost Justification	Actual Cost	Actual Cost Justification
Sub-total	$6,800.00	$2,510.50	N/A	$2,510.50	N/A
Total for all systems	$99,485.34	$25,613.34	N/A	$25,613.34	N/A
Primary Antenna SCA-4DR4S2944	$6,800.00	$2,510.50		$2,510.50
UHF Broadband panel antenna (per panel), horizontally-polarized	$3,500.00	$1,790.50	N/A	$1,790.50	N/A
Cable harness (each, for panel antenna system, if not included in antenna cost)	$2,000.00	$388.00	N/A	$388.00	N/A
Power Dividers (each, for panel antenna system, if not included in antenna cost)	$1,300.00	$332.00	N/A	$332.00	N/A

Components

Actual Information Description	File Name
UHF Broadband panel antenna (per panel), horizontally-polarized	Component Description: Scala/Kathrein: one pair of panel antennas cut to channel-33. Amount: $1,790.50
Cable harness (each, for panel antenna system, if not included in antenna cost)	Component Description: Scala/Kathrein cable harness Amount: $388.00
Power Dividers (each, for panel antenna system, if not included in antenna cost)	Component Description: Power Divider (1). Total cost on invoice is shared 50/50 with station K32OA-D Amount: $332.00

Cost Information

Transmission Line

Information not provided.

Cost Information

Tower Equipment and Rigging Costs

Where no predetermined cost estimate is available, any estimate provided will also become the predetermined cost (displayed in italics).

Description	Predetermined Cost Estimate	Estimated Cost	Estimated Cost Justification	Actual Cost	Actual Cost Justification
Sub-total	$56,883.79	$2,768.79	N/A	$2,768.79	N/A
Total for all systems	$99,485.34	$25,613.34	N/A	$25,613.34	N/A
Primary Tower GTOWER	$56,883.79	$2,768.79		$2,768.79
Replace antennas	$693.79	$693.79	N/A	$693.79	N/A
Tower Rigging Short Tower (less than 500')	$56,190.00	$2,075.00	N/A	$2,075.00	N/A

Components

Actual Information Description	File Name
Replace antennas	Component Description: Air Pipe 2-man crew to remove old channel-51 antennas & power divider, and replace with new channel-33 antennas & power divider; cost share 50/50 with K32OA-D Amount: $693.79
Tower Rigging Short Tower (less than 500')	Component Description: American Tree Service rigging crew, with rental hydraulic self-propelled 2-man hoist to access antennas for replacement; cost shared 50/50 with station K32OA-D Amount: $2,075.00

Cost Information

Outside Professional Services

Where no predetermined cost estimate is available, any estimate provided will also become the predetermined cost (displayed in italics).

Description	Predetermined Cost Estimate	Estimated Cost	Estimated Cost Justification	Actual Cost	Actual Cost Justification
Sub-total	$8,384.65	$3,117.15	N/A	$3,117.15	N/A
Total for all systems	$99,485.34	$25,613.34	N/A	$25,613.34	N/A
Outside Professional Services	$8,384.65	$3,117.15		$3,117.15
Barnett Professional Services	$457.15	$457.15	N/A	$457.15	N/A
Prepare engineering section of FCC Form 2100 (main), License to Cover Application	$1,052.50	$60.00	N/A	$60.00	N/A
Prepare engineering section of FCC Form 2100 (main), Construction Permit Application	$2,102.50	$337.50	N/A	$337.50	N/A
Perform engineering study for displacement application	$1,800.00	$0.00	N/A	$0.00	N/A
Form 399 assistance or other Program Management costs	$1,000.00	$1,000.00	See BWSEstimate K33QB-D.pdf	$1,000.00	N/A
Prepare/ Review 399 reimbursement form	$1,710.00	$1,000.00	Correction assistance for Form 399 Filing.	$1,000.00	N/A
KSPS, PBS-Spokane,WA	$262.50	$262.50	N/A	$262.50	N/A

Components

Actual Information Description	File Name
Barnett Professional Services	Component Description: Total for start-up programming of K33QB-D; invoice total is shared 50/50 with station K32OA-D, also licensed to the applicant & operating in the same building. Amount: $457.15
Prepare engineering section of FCC Form 2100 (main), License to Cover Application	Component Description: BW St.Clair professional service costs are being shared equally with station K32OA-D, since both are owned & operated by this applicant in the same communications building. Amount: $60.00
Prepare engineering section of FCC Form 2100 (main), Construction Permit Application	Component Description: Additional consulting engineering for preparation & filing of application for displacement construction permit; total invoiced cost is shared 50/50 with translator station K32OA-D Amount: $337.50
Perform engineering study for displacement application	Information not provided.
Form 399 assistance or other Program Management costs	Component Description: Assistance & guidance in preparing FCC reimbursement form-399 for filing. Amount: $1,000.00
Prepare/ Review 399 reimbursement form	Component Description: Form 399 Revisions May2020 Amount: $1,000.00
KSPS, PBS-Spokane,WA	Component Description: KSPS technical consulting; one-half the invoice amount is being requested Amount: $262.50

Cost Information

Other Expenses

Where no predetermined cost estimate is available, any estimate provided will also become the predetermined cost (displayed in italics).

Description	Predetermined Cost Estimate	Estimated Cost	Estimated Cost Justification	Actual Cost	Actual Cost Justification
Sub-total	$0.00	$0.00	N/A	$0.00	N/A
Total for all systems	$99,485.34	$25,613.34	N/A	$25,613.34	N/A
Other Expenses	$0.00	$0.00		$0.00

Components

Information not provided.

Cost Information

Grand Total

	Predetermined Cost Estimate	Estimated Cost	Actual Cost
Total for all systems	$99,485.34	$25,613.34	$25,613.34

Reimbursement Status

Question	Response
The facility has ceased operating on its pre-auction channel.	Yes
Construction of final facilities or all necessary modifications are complete.	Yes
All receipts for reimbursement have been submitted no further costs are expected to be incurred. Note this will lock the Form 399 from further editing and begin close-out procedures with the Fund Administrator.	No

Certification

Section	Question	Response
Submission of Estimated Expenses Statements	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), AND ANY FALSE STATEMENTS COULD SUBJECT THIS ENTITY TO LIABILITY UNDER THE FALSE CLAIMS ACT.
The Authorized Person signing below certifies that he/she is authorized to submit this TV Broadcaster Relocation Fund Reimbursement Form on behalf of the above-named entity. The above-named entity acknowledges that all certifications and attached documentation are considered material representations. The above-named entity acknowledges the submission of the information herein creates no obligation on the part of the government to pay any amount. The above-named entity certifies that the equipment and services paid for with money from the TV Broadcaster Relocation Fund are necessary to change channels (broadcasters) or to continue to carry the signal of a broadcaster that changes channels (MVPD). The above-named entity certifies that all payments from the TV Broadcaster Relocation Fund (Fund) received by the entity listed on this form will be used only for expenses that are eligible for reimbursement from the Fund. The above-named entity certifies that it will maintain and provide to the Commission detailed records, including receipts, of all costs eligible for reimbursement actually incurred. The above-named entity acknowledges that overpayments or payments in error must be promptly refunded to the Commission. The above-named entity certifies that it is in full compliance with all statutes, rules, regulations and governmental requirements for which compliance is a pre-requisite for obtaining the payments herein requested.
I declare, under penalty of perjury, that I am an authorized representative of the above-named applicant for the Authorization(s) specified above.	Susan Hansen Consultant 07/17/2020

Section

Question

Response

Submission of Estimated Expenses Statements

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), AND ANY FALSE STATEMENTS COULD SUBJECT THIS ENTITY TO LIABILITY UNDER THE FALSE CLAIMS ACT.

The Authorized Person signing below certifies that he/she is authorized to submit this TV Broadcaster Relocation Fund Reimbursement Form on behalf of the above-named entity.
The above-named entity acknowledges that all certifications and attached documentation are considered material representations.
The above-named entity acknowledges the submission of the information herein creates no obligation on the part of the government to pay any amount.
The above-named entity certifies that the equipment and services paid for with money from the TV Broadcaster Relocation Fund are necessary to change channels (broadcasters) or to continue to carry the signal of a broadcaster that changes channels (MVPD).
The above-named entity certifies that all payments from the TV Broadcaster Relocation Fund (Fund) received by the entity listed on this form will be used only for expenses that are eligible for reimbursement from the Fund.
The above-named entity certifies that it will maintain and provide to the Commission detailed records, including receipts, of all costs eligible for reimbursement actually incurred.
The above-named entity acknowledges that overpayments or payments in error must be promptly refunded to the Commission.
The above-named entity certifies that it is in full compliance with all statutes, rules, regulations and governmental requirements for which compliance is a pre-requisite for obtaining the payments herein requested.

I declare, under penalty of perjury, that I am an authorized representative of the above-named applicant for the Authorization(s) specified above.

Susan Hansen

Consultant

07/17/2020

Certification

Section	Question	Response
Submission of Final Allocation or Accounting Information Statements	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), AND ANY FALSE STATEMENTS COULD SUBJECT THIS ENTITY TO LIABILITY UNDER THE FALSE CLAIMS ACT.
The Authorized Person signing below certifies and represents that he/she is authorized to submit this TV Broadcaster Relocation Fund Reimbursement Form on behalf of the above-named entity. The above-named entity acknowledges that all certifications and attached documentation are considered material representations. The above-named entity acknowledges the submission of the information herein creates no obligation on the part of the government to pay any amount. The above-named entity certifies that all costs identified as "actual costs" herein accurately represent the costs actually paid by the above-named entity, including any discounts, refunds, or rebates. The above-named entity certifies that all payments from the TV Broadcaster Relocation Fund (Fund) received by the entity listed on this form will be used only for expenses that are eligible for reimbursement from the Fund. The above-named entity acknowledges that overpayments or payments in error must be promptly refunded to the Commission. The above-named entity certifies that it is in full compliance with all statutes, rules, regulations and governmental requirements for which compliance is a pre-requisite for obtaining the payments herein requested.
I declare, under penalty of perjury, that I am an authorized representative of the above-named applicant for the Authorization(s) specified above.	Larry Ayer Acting Chairman 07/17/2020

Section

Question

Response

Submission of Final Allocation or Accounting Information Statements

The Authorized Person signing below certifies and represents that he/she is authorized to submit this TV Broadcaster Relocation Fund Reimbursement Form on behalf of the above-named entity. The above-named entity acknowledges that all certifications and attached documentation are considered material representations.
The above-named entity acknowledges the submission of the information herein creates no obligation on the part of the government to pay any amount.
The above-named entity certifies that all costs identified as "actual costs" herein accurately represent the costs actually paid by the above-named entity, including any discounts, refunds, or rebates.
The above-named entity certifies that all payments from the TV Broadcaster Relocation Fund (Fund) received by the entity listed on this form will be used only for expenses that are eligible for reimbursement from the Fund.
The above-named entity acknowledges that overpayments or payments in error must be promptly refunded to the Commission.
The above-named entity certifies that it is in full compliance with all statutes, rules, regulations and governmental requirements for which compliance is a pre-requisite for obtaining the payments herein requested.

I declare, under penalty of perjury, that I am an authorized representative of the above-named applicant for the Authorization(s) specified above.

Larry Ayer

Acting Chairman

07/17/2020

(REFERENCE COPY - Not for submission) FCC Form 399: Reimbursement Request

Applicant Information

Applicant Name, Type, and Contact Information

Reimbursement Contact Information

Reimbursement Contact Name and Information

Preparer Contact Information

Preparer Contact Name and Information

Broadcaster Information and Transition Plan

Transmitters

Primary Transmitter

Existing Transmitter Information

Primary Transmitter

New Transmitter Costs

Primary Transmitter

Other Transmitter Costs

Primary Transmitter

Other Transmitter Cost Not Listed

Antennas

Primary Antenna

Existing Antenna Information

Primary Antenna

New Antenna Costs

Primary Antenna

Other Antenna Costs

Primary Antenna

Other Antenna Cost Not Listed

Transmission Line

Tower Equipment And Rigging Costs

Primary Tower

Existing Tower

Other Types of Users

Primary Tower

Tower Rigging Costs

Primary Tower

Other Tower Expenses Not Listed

Outside Professional Services Costs

Outside Professional Services Costs

Other Professional Services Expenses Not Listed

Other Expenses

Other Expenses

Other Expenses Not Listed

Cost Information

Transmitters

Components

Cost Information

Antennas

Components

Cost Information

Transmission Line

Cost Information

Tower Equipment and Rigging Costs

Components

Cost Information

Outside Professional Services

Components

Cost Information

Other Expenses

Components

Cost Information

Grand Total

Reimbursement Status

Certification

Certification

Attachments