Applicant | Address | Phone | Applicant Type | |
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WMTM, LLC |
5670 Wilshire Blvd., Suite 1620 Los Angeles, CA 90036 United States |
+1 (323) 965-5400 | rogow@loop.com | Limited Liability Company |
Applicant | Address | Phone | |
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[Confidential] |
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Applicant | Address | Phone | |
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The Preparer is same as the reimbursement contact. |
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Question | Response |
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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. | No |
Briefly describe transition plan | he plan is for WAZT-CD is to replace the existing channel 45 system with a new channel 30 antenna, new 1-5/8" line and new transmitter. |
Section | Question | Response |
---|---|---|
Transmitter Related Expenses | Do you have transmitter related expenses? | Yes |
Section | Question | Response |
---|---|---|
Existing Transmitter Description | Type of change | Retune Existing |
Use | Primary (Main) | |
Ownership | Owned | |
Owner | N/A | |
Is this transmitter currently shared with another station? | No | |
Is this transmitter currently in operating condition? | Yes | |
Existing Transmitter Manufacturer and Type | Manufacturer | Rohde & Schwarz |
Model | NV8306 | |
Year | 2012 | |
Type | Solid State | |
Solid State Cooling | Air Cooled | |
Solid State Power capacity | 1.9 kW |
Section | Question | Response |
---|---|---|
New IOT Tubes | Number of Tubes (including accessories) needed | N/A |
New Mask Filter | ||
Power | 3 kW | |
Other Power | N/A | |
New Exciter | Is a new exciter needed? | No |
Section | Question | Response |
---|---|---|
Electrical Service | Service Entrance (3 phases 800A 208V) | No |
Switchgear (industrial 800 amp) | No | |
Transformer (480V) | No | |
Power | N/A | |
Rigid Conduit and Wiring | Yes | |
Size | 4 inches | |
Length | 10.0 feet | |
Other Electrical Service | Yes | |
Description | 40 amp circuit breaker and box assembly. | |
HVAC Service | Does the replacement transmitter require HVAC Service? | No |
Type | N/A | |
Size | N/A | |
Other Size | N/A | |
Transmitter Building Addition/Modification or Leasehold Improvement | Does the Transmitter Building require an addition, modification, other leashold improvement? | No |
Size | N/A | |
Channel 14 Costs | Is an RF Consulting Engineer needed? | N/A |
Is a channel 14 Mask Filer needed? | N/A | |
Is additional field engineering time needed? | N/A | |
Number of Days | N/A |
Section | Question | Response |
---|---|---|
New Transmitter | Use | Interim |
Description of Use | N/A | |
Change Type | Purchase | |
Manufacturer | ||
Model | TMU9-5 | |
Transmitter Type | Solid State | |
Solid State Cooling | Air Cooled | |
Solid State Power capacity | 3.0 kW | |
Justification for New Transmitter | WAZT-CD needs an interim transmitter to remain on the air while it returns its existing transmitter. |
Section | Question | Response |
---|---|---|
Electrical Service | Service Entrance (3 phases 800A 208V) | No |
Switchgear (industrial 800 amp) | No | |
Transformer (480V) | No | |
Power | N/A | |
Rigid Conduit and Wiring | Yes | |
Size | 4 inches | |
Length | 10.0 feet | |
Other Electrical Service | Yes | |
Description | 40 amp circuit breaker and box assembly. | |
HVAC Service | Does the replacement transmitter require HVAC Service? | No |
Type | N/A | |
Size | N/A | |
Other Size | N/A | |
Transmitter Building Addition/Modification or Leasehold Improvement | Does the Transmitter Building require an addition, modification, other leashold improvement? | No |
Size | N/A | |
Channel 14 Costs | Is an RF Consulting Engineer needed? | N/A |
Is a channel 14 Mask Filer needed? | N/A | |
Is additional field engineering time needed? | N/A | |
Number of Days | N/A | |
Inside RF System | Is an additional interior RF system required to support this interim transmitter? | Yes |
Section | Question | Response |
---|---|---|
Antenna Related Expenses | Do you have antenna related expenses? | Yes |
Section | Question | Response |
---|---|---|
Existing Antenna Description | Type of change | Purchase New |
Antenna Use | Primary (Main) | |
Description of Use | N/A | |
Ownership | Owned | |
Owner | N/A | |
Site | N/A | |
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 | Class | Class A |
Mounting | Side Mount | |
Antenna position in stack | Not in Stack | |
Polarization | Circular | |
Type | Slotted Coaxial | |
Number of Stations Supported | N/A | |
Number of Panels | N/A | |
Design power capacity in use | N/A | |
Lower Limit | N/A | |
Upper Limit | N/A | |
Other Antenna Type | N/A | |
ERP: | 4.8 kW | |
Manufacturer | ||
Model | TLP4ER | |
Year | 2015 |
Section | Question | Response |
---|---|---|
New Antenna Description | Use | Primary (Main) |
Description of Use | N/A | |
Change Type | Purchase New | |
Is this a request for upgraded equipment? | No | |
Ownership | Owned | |
Owner | N/A | |
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 | Class | Class A |
Mounting | Side Mount | |
Antenna position in stack | Not in Stack | |
Polarization | Elliptical | |
Type | Slotted Coaxial | |
Number of Stations Supported | N/A | |
Number of Panels/Bays | N/A | |
Lower Limit | N/A | |
Upper Limit | N/A | |
Design power capacity in use | N/A | |
Other Antenna Type | N/A | |
ERP: | 3.58 kW | |
Manufacturer | ||
Model | TFU-12DSB/VP-BB-B | |
Year | 2017 | |
Justification for New Antenna | The existing antenna is a single channel slotted Coaxial antenna. It is not capable of operating on the new channel. Moreover, WAZT-CD is returning it's transmitter and will require new transmission line for an interim facility to remain on the air. |
Section | Question | Response |
---|---|---|
Combiner for Shared Antenna | Do you need a Combiner for a Shared Antenna? | |
Type | ||
Number of channels supported | N/A | |
Frequencies of channels supported | N/A | |
Frequency | N/A | |
Do you need a combiner output splitter/switcher for dual feed lines? | N/A | |
Elbow Complex | Do you require the separate purchase of the Elbow Complex? | No |
Broadband or Single Channel? | N/A | |
Feed Line Size | N/A | |
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? | Yes |
Sweep Test | Do you require the sweep testing of transmission line and antenna? | Yes |
Section | Question | Response |
---|---|---|
Transmission Line Related Expenses | Do you have transmission line related expenses? | Yes |
Section | Question | Response |
---|---|---|
Existing Transmission Line Description | Type of change | Purchase New |
Use | Primary (Main) | |
Description of Use | N/A | |
Ownership | Owned | |
Owner | N/A | |
Site | N/A | |
Is the existing transmission line shared with another station or stations? | No | |
Is Transmission Line in operating condition? | Yes | |
Existing Transmission Line Manufacturer and Type | Manufacturer | |
Type | Flexible Foam | |
Diameter | 1 5/8 inches | |
Other Diameter | N/A | |
Segment Length | N/A | |
Other Segment Length | N/A | |
Number of parallel runs | 1 | |
Length | 200 feet per run |
Section | Question | Response |
---|---|---|
New Transmission Line Costs | Use | Primary (Main) |
Description of Use | N/A | |
Change Type | Purchase New | |
Is this a request for upgraded equipment? | No | |
Type | Flexible Air | |
Diameter | 1 5/8 inches | |
Other Diameter | N/A | |
Segment Length | N/A | |
Other Segment Length | N/A | |
Number of parallel runs | 1 | |
Length | 200 feet per run | |
Justification for New Transmission Line | WAZT-CD is returning it's transmitter and will require new transmission line for an interim facility to remain on the air. |
Section | Question | Response |
---|---|---|
Tower Equipment or Rigging Costs Changes | Do you have tower equipment or rigging costs changes? | Yes |
Section | Question | Response |
---|---|---|
Existing Tower Description | Type of change | Modify Existing |
Tower Use | Primary (Main) | |
Description of Use | N/A | |
Ownership | Leased | |
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? | No | |
Is tower compliant with Rev G? | No | |
Existing Tower Structure Registration | Do you have a tower registration number? | No |
ASR Number | ||
Coordinates (NAD83) | Latitude (NAD83) | 38° 52' 19.5" N- |
Longitude (NAD83) | 077° 41' 55.0" W- | |
Overall Structure Height | 49.70 feet | |
Support Structure Height | 49.70 feet | |
Ground Elevation Above Mean Sea Level (AMSL) | 353.90 feet | |
Structure Type | TOWER - Free Standing or Guyed Structure | |
Tower Owner | American Tower | |
Date Constructed | 08/14/1950 |
Users |
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T-Mobile |
Section | Question | Response |
---|---|---|
Engineering Study | Please what type of engineering study is required, if any: | Study needed for undocumented/poorly documented tower |
Tower Reinforcements | Please select whether tower reinforcements are needed: | No reinforcements needed |
Section | Question | Response |
---|---|---|
Tower Rigging Costs | Complex Tower | N/A |
Helicopter Services Required | Are helicopter services required? | No |
Name | Description |
---|---|
Structural Analysis |
After the mapping is complete, The structural analysis will need to be completed. |
Section | Question | Response |
---|---|---|
Outside Project Management Services | Do you require outside project management services? | Yes |
Number of Hours | 2000 | |
Explanation | WAZT-CD does not have sufficient resource capacity and expertise in house to handle all of the Project Management related tasks necessary to facility on-time completion of the station's build by the Construction Deadline | |
Outside RF consulting Engineering Services | Perform engineering study for new channel assignment and antenna development | 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 | Yes | |
Quantity | 1 | |
Do you have Distributed Transmission System engineering services? | N/A | |
Critical Facility | N/A | |
Terrain-Shielded Facility | N/A | |
Attorney and Other Outside Consulting Services | Prepare and file Form FCC Construction Permit Application | Yes |
For Auxiliary Facility | No | |
For Main Facility | Yes | |
Prepare and file Form FCC License to Cover Application | Yes | |
For Auxiliary Facility | No | |
For Main Facility | Yes | |
Prepare request for Special Temporary Authority | Yes | |
Quantity | 1 | |
NEPA Section 106 environmental review | No | |
Environmental Assessment | No | |
ASR Modification | No | |
FAA Consultation (including preparation of FAA Form 7460) | No | |
Negotiation of Lease and other Matter for Shared Locations | Yes | |
Prepare or Review FCC Form 399 for Reimbursement | Yes | |
Address transition timing and coordination issues w/ other stations and wireless providers | Yes | |
RF Field Engineering Services | Comprehensive coverage verification via field study | Yes |
RF exposure measurements | Yes | |
Additional Field Engineering Service | Yes | |
Number of Days | 8 | |
Justification | RF Project management of tower and transmitter installs |
Section | Question | Response |
---|---|---|
AM Pattern Disturbance | Is an Impact Study needed? | No |
Is Remediation needed? | No | |
Facility Expenses | Name | N/A |
Other Distributed Transmission System Expenses Not listed | N/A | |
Name | N/A | |
Is Notification of a Medical Facility required as a result of DTV broadcasting? | Yes | |
Permit and Filing Costs | Local Zoning | Yes |
Non-zoning permits | Yes | |
BLM or NFS Coordination | No | |
FCC Construction Permit Minor Change | No | |
FCC License to Cover Application | Yes | |
FCC Special Temporary Authority Application | Yes | |
Other Miscellaneous Expenses | Does this relocation require paying Disposal Costs (for equipment and other waste, net of any salvage value)? | Yes |
Does this relocation require Equipment Delivery or Handling Charges not otherwise included in individual item costs? | Yes | |
Does this relocation require Equipment Storage? | Yes | |
Does this relocation require the Development and Airing of an Announcement regarding an upcoming channel change? | Yes | |
Does this relocation require MVPD Notification of a Channel Change? | Yes |
Name | Description |
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Vehicle Rentals |
Required for equipment delivery. |
Description | Predetermined Cost Estimate |
Estimated Cost | Estimated Cost Justification | Actual Cost | Actual Cost Justification |
---|---|---|---|---|---|
Sub-total | $417,475.00 | $404,470.00 | N/A | $55,207.51 | N/A |
Total for all systems | $1,130,555.00 | $1,106,066.50 | N/A | $151,171.13 | N/A |
Interim Transmitter TMU9-5 | $305,610.00 | $298,060.00 | $55,207.51 | ||
UHF - Air Cooled Solid State Transmitter 2.501 - 3.999 kW | $155,600.00 | $155,600.00 | N/A | $55,207.51 | N/A |
4" Rigid Conduit and Wiring (Cost per foot) | $1,010.00 | $960.00 | N/A | N/A | N/A |
Other Electrical Service: 40 amp circuit breaker and box assembly. | $1,500.00 | $1,500.00 | N/A | N/A | N/A |
UHF inside RF system including switching | $147,500.00 | $140,000.00 | N/A | N/A | N/A |
Primary Transmitter NV8306 | $111,865.00 | $106,410.00 | $0.00 | ||
Other Electrical Service: 40 amp circuit breaker and box assembly. | $1,500.00 | $1,500.00 | N/A | N/A | N/A |
4" Rigid Conduit and Wiring (Cost per foot) | $1,010.00 | $960.00 | N/A | N/A | N/A |
3 kW mask filter | $4,155.00 | $3,950.00 | N/A | N/A | N/A |
UHF and VHF - minor banding issues | $105,200.00 | $100,000.00 | N/A | N/A | N/A |
Actual Information Description | File Name |
---|---|
UHF - Air Cooled Solid State Transmitter 2.501 - 3.999 kW | |
4" Rigid Conduit and Wiring (Cost per foot) | Information not provided. |
Other Electrical Service: 40 amp circuit breaker and box assembly. | Information not provided. |
UHF inside RF system including switching | Information not provided. |
Other Electrical Service: 40 amp circuit breaker and box assembly. | Information not provided. |
4" Rigid Conduit and Wiring (Cost per foot) | Information not provided. |
3 kW mask filter | Information not provided. |
UHF and VHF - minor banding issues | Information not provided. |
Description | Predetermined Cost Estimate |
Estimated Cost | Estimated Cost Justification | Actual Cost | Actual Cost Justification |
---|---|---|---|---|---|
Sub-total | $33,030.00 | $51,431.50 | N/A | $45,031.50 | N/A |
Total for all systems | $1,130,555.00 | $1,106,066.50 | N/A | $151,171.13 | N/A |
Primary Antenna TFU-12DSB/VP-BB-B | $33,030.00 | $51,431.50 | $45,031.50 | ||
UHF - Lower Power Side Mount, Class A One Station antenna -- basic | $26,300.00 | $45,031.50 | See quote from Dielectric | $45,031.50 | N/A |
Sweep test of existing antenna | $6,730.00 | $6,400.00 | N/A | N/A | N/A |
Actual Information Description | File Name |
---|---|
UHF - Lower Power Side Mount, Class A One Station antenna -- basic | |
Sweep test of existing antenna | Information not provided. |
Description | Predetermined Cost Estimate |
Estimated Cost | Estimated Cost Justification | Actual Cost | Actual Cost Justification |
---|---|---|---|---|---|
Sub-total | $6,600.00 | $6,200.00 | N/A | $4,734.97 | N/A |
Total for all systems | $1,130,555.00 | $1,106,066.50 | N/A | $151,171.13 | N/A |
Primary Transmission Line | $6,600.00 | $6,200.00 | $4,734.97 | ||
Flexible Air Transmission Line - dielectric, 1 5/8" | $6,600.00 | $6,200.00 | N/A | $4,734.97 | N/A |
Actual Information Description | File Name |
---|---|
Flexible Air Transmission Line - dielectric, 1 5/8" |
Description | Predetermined Cost Estimate |
Estimated Cost | Estimated Cost Justification | Actual Cost | Actual Cost Justification |
---|---|---|---|---|---|
Sub-total | $122,500.00 | $117,000.00 | N/A | $1,500.00 | N/A |
Total for all systems | $1,130,555.00 | $1,106,066.50 | N/A | $151,171.13 | N/A |
Primary Tower TOWER | $122,500.00 | $117,000.00 | $1,500.00 | ||
Structural Analysis | $12,000.00 | $12,000.00 | N/A | $1,500.00 | N/A |
Short Tower (less than 500') | $84,200.00 | $80,000.00 | N/A | N/A | N/A |
Tower mapping for an undocumented/poorly documented tower and preparation of documentation necessary for tower load study | $26,300.00 | $25,000.00 | N/A | N/A | N/A |
Actual Information Description | File Name |
---|---|
Structural Analysis | |
Short Tower (less than 500') | Information not provided. |
Tower mapping for an undocumented/poorly documented tower and preparation of documentation necessary for tower load study | Information not provided. |
Description | Predetermined Cost Estimate |
Estimated Cost | Estimated Cost Justification | Actual Cost | Actual Cost Justification |
---|---|---|---|---|---|
Sub-total | $472,170.00 | $448,750.00 | N/A | $24,567.85 | N/A |
Total for all systems | $1,130,555.00 | $1,106,066.50 | N/A | $151,171.13 | N/A |
Outside Professional Services | $472,170.00 | $448,750.00 | $24,567.85 | ||
Additional Field Engineering Service, 8 Days | $16,000.00 | $16,000.00 | N/A | N/A | N/A |
RF Exposure Measurements | $21,050.00 | $20,000.00 | N/A | N/A | N/A |
Comprehensive coverage verification via field study, if needed | $84,200.00 | $80,000.00 | N/A | N/A | N/A |
Attorney Fees - Prepare and File request for Special Temporary Authorization | $3,680.00 | $3,500.00 | N/A | N/A | N/A |
Attorney Fees - Negotiation of lease and other matters for shared locations | $4,210.00 | $4,000.00 | N/A | N/A | N/A |
Attorney Fees -Prepare and File FCC Form 2100 (main), License to Cover Application | $2,365.00 | $2,250.00 | N/A | N/A | N/A |
Attorney Fees - Prepare and File FCC Form 2100 (main), Construction Permit Application | $5,260.00 | $5,000.00 | N/A | N/A | N/A |
Prepare request for Special Temporary Authorization | $2,050.00 | $1,500.00 | N/A | N/A | N/A |
Project management of the transition | $316,000.00 | $300,000.00 | N/A | $19,235.50 | N/A |
Prepare and or review reimbursement form | $2,630.00 | $2,500.00 | N/A | $532.35 | N/A |
Address transition timing and coordination issues w/ other stations and wireless | $2,630.00 | $2,500.00 | N/A | N/A | N/A |
Perform engineering study for new channel assignment and antenna development | $7,360.00 | $7,000.00 | N/A | $2,400.00 | N/A |
Prepare engineering section of FCC Form 2100 (main), Construction Permit Application | $3,155.00 | $3,000.00 | N/A | $2,400.00 | N/A |
Prepare engineering section of FCC Form 2100 (main), License to Cover Application | $1,580.00 | $1,500.00 | N/A | N/A | N/A |
Actual Information Description | File Name |
---|---|
Additional Field Engineering Service, 8 Days | Information not provided. |
RF Exposure Measurements | Information not provided. |
Comprehensive coverage verification via field study, if needed | Information not provided. |
Attorney Fees - Prepare and File request for Special Temporary Authorization | Information not provided. |
Attorney Fees - Negotiation of lease and other matters for shared locations | Information not provided. |
Attorney Fees -Prepare and File FCC Form 2100 (main), License to Cover Application | Information not provided. |
Attorney Fees - Prepare and File FCC Form 2100 (main), Construction Permit Application | Information not provided. |
Prepare request for Special Temporary Authorization | Information not provided. |
Project management of the transition | |
Prepare and or review reimbursement form | |
Address transition timing and coordination issues w/ other stations and wireless | Information not provided. |
Perform engineering study for new channel assignment and antenna development | |
Prepare engineering section of FCC Form 2100 (main), Construction Permit Application | |
Prepare engineering section of FCC Form 2100 (main), License to Cover Application | Information not provided. |
Description | Predetermined Cost Estimate |
Estimated Cost | Estimated Cost Justification | Actual Cost | Actual Cost Justification |
---|---|---|---|---|---|
Sub-total | $78,780.00 | $78,215.00 | N/A | $20,129.30 | N/A |
Total for all systems | $1,130,555.00 | $1,106,066.50 | N/A | $151,171.13 | N/A |
Other Expenses | $78,780.00 | $78,215.00 | $20,129.30 | ||
Vehicle Rentals | $5,000.00 | $5,000.00 | N/A | N/A | N/A |
DTV Medical Facility Notification | $11,550.00 | $11,000.00 | N/A | $10,658.00 | N/A |
FCC Filing Fees - Form 2100 license to cover application | $335.00 | $325.00 | N/A | N/A | N/A |
FCC Filing Fees - Special Temporary Authorization request | $195.00 | $190.00 | N/A | N/A | N/A |
Local Zoning | $5,000.00 | $5,000.00 | N/A | N/A | N/A |
Non-zoning permits | $4,700.00 | $4,700.00 | Actual cost is higher than predetermined cost estimate. | $4,700.00 | N/A |
Disposal Costs (for equipment and other waste, net of any salvage value) | $10,000.00 | $10,000.00 | N/A | $935.74 | N/A |
MVPD Notification of Channel Change | $2,000.00 | $2,000.00 | N/A | N/A | N/A |
Develop and air announcement of upcoming channel change | $15,000.00 | $15,000.00 | N/A | N/A | N/A |
Equipment Storage | $10,000.00 | $10,000.00 | N/A | N/A | N/A |
Equipment Delivery and Handling Charges | $15,000.00 | $15,000.00 | N/A | $3,835.56 | N/A |
Actual Information Description | File Name |
---|---|
Vehicle Rentals | Information not provided. |
DTV Medical Facility Notification | |
FCC Filing Fees - Form 2100 license to cover application | Information not provided. |
FCC Filing Fees - Special Temporary Authorization request | Information not provided. |
Local Zoning | Information not provided. |
Non-zoning permits | |
Disposal Costs (for equipment and other waste, net of any salvage value) | |
MVPD Notification of Channel Change | Information not provided. |
Develop and air announcement of upcoming channel change | Information not provided. |
Equipment Storage | Information not provided. |
Equipment Delivery and Handling Charges |
Predetermined Cost Estimate |
Estimated Cost | Actual Cost | |
---|---|---|---|
Total for all systems | $1,130,555.00 | $1,106,066.50 | $151,171.13 |
Question | Response |
---|---|
The facility has ceased operating on its pre-auction channel. | No |
Construction of final facilities or all necessary modifications are complete. | No |
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 |
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. |
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I declare, under penalty of perjury, that I am an authorized representative of the above-named applicant for the Authorization(s) specified above. | Andy Wilcoxson General Manager 05/20/2020 |
Section | Question | Response |
---|---|---|
Submission of Actual Cost Documentation Statements | WILLFUL FALSE, FRAUDULENT, OR FICTITIOUS STATEMENTS ON THIS FORM ARE PUNISHABLE BY FINE AND/OR IMPRISIONMENT (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 AND/OR FRAUDULENT STATEMENTS COULD SUBJECT THIS ENTITY TO LIABILITY UNDER THE FALSE CLAIMS ACT (U.S. CODE, TITLE 31, SECTIONS 3729-3733). |
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I declare, under penalty of perjury, that I am an authorized representative of the above-named applicant for the Authorization(s) specified above. | Andy Wilcoxson General Manager 05/20/2020 |