TV Broadcaster Relocation Fund Reimbursement Application

Applicant Information

Applicant Name, Type, and Contact Information

Applicant	Address	Phone	Email	Applicant Type
LAWRENCE F. LOESCH Sole Proprietorship Doing Business As: LAWRENCE F. LOESCH	P.O. BOX 1418 NAGS HEAD, NC 27959 United States	+1 (252) 449-8331	rloesch@ecri.net	Other

Applicant

Address

Phone

Applicant Type

LAWRENCE F. LOESCH

Sole Proprietorship

Doing Business As: LAWRENCE F. LOESCH

P.O. BOX 1418

NAGS HEAD, NC 27959

United States

+1 (252) 449-8331

rloesch@ecri.net

Other

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
J Benjamin Davis Brooks, Pierce et al.	150 Fayetteville Street Suite 1700 Raleigh, NC 27601 United States	+1 (919) 839-0300	bdavis@brookspierce.com

Applicant

Address

Phone

J Benjamin Davis

Brooks, Pierce et al.

150 Fayetteville Street

Suite 1700

Raleigh, NC 27601

United States

+1 (919) 839-0300

bdavis@brookspierce.com

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	Please see attached exhibit titled FCC Form 399 Displacement Plan Description

Question	Response
Sharee Station Facility ID	125413
Call Sign	W24EC-D
Type
Licensee Name	LAWRENCE F. LOESCH
Status	LICENSED
DTS	No
Community of License	MANTEO, NC
Pre-auction RF Channel	24
Post-auction RF Channel
Neilsen DMA
Network Affiliation

Question	Response
Sharee Station Facility ID	73366
Call Sign	WOBR-FM
Type	Commercial
Licensee Name	EAST CAROLINA RADIO, INC.
Status	LICENSED
DTS	No
Community of License	WANCHESE, NC
Pre-auction RF Channel	237
Post-auction RF Channel
Neilsen DMA
Network Affiliation

Question	Response
Sharee Station Facility ID	125383
Call Sign	W28CJ-D
Type
Licensee Name	LAWRENCE F. LOESCH
Status	LICENSED
DTS	No
Community of License	MANTEO, NC
Pre-auction RF Channel	28
Post-auction RF Channel
Neilsen DMA
Network Affiliation

Question	Response
Sharee Station Facility ID	125393
Call Sign	W17CT-D
Type
Licensee Name	LAWRENCE F. LOESCH
Status	LICENSED
DTS	No
Community of License	MANTEO, NC
Pre-auction RF Channel	17
Post-auction RF Channel
Neilsen DMA
Network Affiliation

Question	Response
Sharee Station Facility ID	190587
Call Sign	W22EN-D
Type
Licensee Name	LAWRENCE F. LOESCH
Status	LICENSED
DTS	No
Community of License	MANTEO, NC
Pre-auction RF Channel	22
Post-auction RF Channel
Neilsen DMA
Network Affiliation

Question	Response
Sharee Station Facility ID	130375
Call Sign	W30DN-D
Type
Licensee Name	LAWRENCE F. LOESCH
Status	LICENSED
DTS	No
Community of License	MANTEO, NC
Pre-auction RF Channel	30
Post-auction RF Channel
Neilsen DMA
Network Affiliation

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?	Yes
	Is this transmitter currently in operating condition?	Yes
Existing Transmitter Manufacturer and Type	Manufacturer
	Model	TAUD500
	Year	2012
	Type	Solid State
	Solid State Cooling	Air Cooled
	Solid State Power Capacity	500 W

Facility ID's and Call Signs of all stations with whom the transmitter is shared.

Facility ID	Call Sign
130375	W30DN-D
125413	W24EC-D
73366	WOBR-FM
190587	W22EN-D
125393	W17CT-D
125383	W28CJ-D

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	TMU9-1
	Transmitter Type	Solid State
	Solid State Cooling	Air Cooled
	Solid State Power capacity	600 W
	Justification for New Transmitter	Please see attached exhibit titled FCC Form 399 Displacement Plan Description

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	Yes
	Size	3 inches
	Length	20.0 feet
	Other Electrical Service	No
HVAC Service	Does the replacement transmitter require HVAC Service?	No
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
RF System 6 Channel Manifold	Dielectric RF System 6 Channel Manifold

Antennas

Section	Question	Response
Antenna Related Expenses	Do you have antenna related expenses?	No

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?	No

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	Yes
	Quantity	2
	Prepare Form 601	No
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	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	No
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
Additional Repack Legal Services Not Otherwise Specified in Form 399	Non-Catalog Legal Services such as review of other miscellaneous non-catalog legal fees

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	Yes
	FCC License to Cover Application	Yes
	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?	Yes
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	$61,085.00	$65,572.72	N/A	$64,532.72	N/A
Total for all systems	$80,357.50	$91,745.32	N/A	$78,797.32	N/A
Primary Transmitter TMU9-1	$61,085.00	$65,572.72		$64,532.72
RF System 6 Channel Manifold	$31,945.00	$31,945.00	N/A	$31,945.00	N/A
UHF - Air Cooled Solid State Transmitter 320 - 700 Watts	$28,100.00	$32,587.72	Existing transmitter cannot be retuned to the required frequency.	$32,587.72	Additional expenses were incurred as indicated in the attached invoices.
3" Rigid Conduit and Wiring (Cost per foot)	$1,040.00	$1,040.00	N/A	N/A	N/A

Components

Actual Information Description	File Name
RF System 6 Channel Manifold	Component Description: Combiner and freight Amount: $31,945.00
UHF - Air Cooled Solid State Transmitter 320 - 700 Watts	Component Description: New Transmitter plus taxes Amount: $32,587.72
3" Rigid Conduit and Wiring (Cost per foot)	Information not provided.

Cost Information

Antennas

Information not provided.

Cost Information

Transmission Line

Information not provided.

Cost Information

Tower Equipment and Rigging Costs

Information not provided.

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	$16,327.50	$23,227.60	N/A	$14,094.60	N/A
Total for all systems	$80,357.50	$91,745.32	N/A	$78,797.32	N/A
Outside Professional Services	$16,327.50	$23,227.60		$14,094.60
Attorney Fees -Prepare and File FCC Form 2100 (main), License to Cover Application	$1,577.50	$1,577.50	N/A	$302.50	N/A
Attorney Fees - Prepare and File FCC Form 2100 (main), Construction Permit Application	$3,025.00	$3,025.00	N/A	$817.50	N/A
Prepare engineering section of FCC Form 2100 (main), License to Cover Application	$1,052.50	$1,052.50	N/A	N/A	N/A
Prepare engineering section of FCC Form 2100 (main), Construction Permit Application	$2,102.50	$2,102.50	N/A	$1,000.00	N/A
Prepare request for Special Temporary Authorization	$2,560.00	$4,041.00	Additional expenses were incurred as indicated in the attached invoices.	$4,041.00	Additional expenses were incurred as indicated in the attached invoices.
Perform engineering study for displacement application	$1,800.00	$1,800.00	N/A	$0.00	N/A
Prepare/ Review 399 reimbursement form	$1,710.00	$7,129.10	Additional expenses were incurred as indicated in the attached invoices.	$7,129.10	Additional expenses were incurred as indicated in the attached invoices.
Additional Repack Legal Services Not Otherwise Specified in Form 399	$2,500.00	$2,500.00	N/A	$804.50	N/A

Components

Actual Information Description	File Name
Attorney Fees -Prepare and File FCC Form 2100 (main), License to Cover Application	Component Description: Prepare and file displacement license application Amount: $302.50
Attorney Fees - Prepare and File FCC Form 2100 (main), Construction Permit Application	Component Description: Legal fees for preparation of displacement construction permit application. Amount: $817.50
Prepare engineering section of FCC Form 2100 (main), License to Cover Application	Information not provided.
Prepare engineering section of FCC Form 2100 (main), Construction Permit Application	Component Description: Prepare Technical Portion of Displacement CP Application Amount: $1,000.00
Prepare request for Special Temporary Authorization	Component Description: Preparation and filing of STA Amount: $3,465.00 Component Description: Prepare request for STA Amount: $417.00 Component Description: Finalize STA extension request Amount: $159.00
Perform engineering study for displacement application	Information not provided.
Prepare/ Review 399 reimbursement form	Component Description: Prepare/ Review 399 reimbursement form Amount: $144.50 Component Description: Prepare/ Review 399 reimbursement form Amount: $260.10 Component Description: Prepare/ Review 399 reimbursement form Amount: $690.00 Component Description: Prepare/ Review 399 reimbursement form Amount: $4,196.00 Component Description: Prepare/ Review 399 reimbursement form Amount: $556.50 Component Description: Prepare/ Review 399 reimbursement form Amount: $192.50 Component Description: Prepare/ Review 399 reimbursement form Amount: $212.00 Component Description: Prepare/ Review 399 reimbursement form Amount: $79.50 Component Description: Prepare/ Review 399 reimbursement form Amount: $82.50 Component Description: Prepare/ Review 399 reimbursement form Amount: $397.50 Component Description: Prepare/ Review 399 reimbursement form Amount: $132.50 Component Description: Prepare/ Review 399 reimbursement form Amount: $106.00 Component Description: Prepare/ Review 399 reimbursement form Amount: $79.50
Additional Repack Legal Services Not Otherwise Specified in Form 399	Component Description: Additional Repack Legal Services Not Otherwise Specified in Form 399 Amount: $54.50 Component Description: Additional Repack Legal Services Not Otherwise Specified in Form 399 Amount: $302.50 Component Description: Additional Repack Legal Services Not Otherwise Specified in Form 399 Amount: $72.00 Component Description: Additional Repack Legal Services Not Otherwise Specified in Form 399 Amount: $103.00 Component Description: Additional Repack Legal Services Not Otherwise Specified in Form 399 Amount: $272.50

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	$2,945.00	$2,945.00	N/A	$170.00	N/A
Total for all systems	$80,357.50	$91,745.32	N/A	$78,797.32	N/A
Other Expenses	$2,945.00	$2,945.00		$170.00
FCC Filing Fees - Form 2100 minor change CP application	$1,110.00	$1,110.00	N/A	$0.00	N/A
FCC Filing Fees - Form 2100 license to cover application	$335.00	$335.00	N/A	$170.00	N/A
Equipment Storage	$1,500.00	$1,500.00	N/A	$0.00	N/A

Components

Actual Information Description	File Name
FCC Filing Fees - Form 2100 minor change CP application	Information not provided.
FCC Filing Fees - Form 2100 license to cover application	Component Description: Filing fee for displacement license application Amount: $170.00
Equipment Storage	Information not provided.

Cost Information

Grand Total

	Predetermined Cost Estimate	Estimated Cost	Actual Cost
Total for all systems	$80,357.50	$91,745.32	$78,797.32

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.	Yes

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.	Lawrence F. Loesch Individual 08/31/2022

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.

Lawrence F. Loesch

Individual

08/31/2022

Certification

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).
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 certifies that the statements in this form and attached documentation are true, complete, and correct. 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 (full power and Class A stations) and/or otherwise modify a television station’s facility as a result of the spectrum repack (LPTV/TV Translator stations); or to minimize service disruption resulting from a repacked television station (FM stations); 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 the cost information/documents submitted reflect costs 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 prerequisite 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.	Lawrence F. Loesch Individual 08/31/2022

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).

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 certifies that the statements in this form and attached documentation are true, complete, and correct.
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 (full power and Class A stations) and/or otherwise modify a television station’s facility as a result of the spectrum repack (LPTV/TV Translator stations); or to minimize service disruption resulting from a repacked television station (FM stations); 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 the cost information/documents submitted reflect costs 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 prerequisite 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.

Lawrence F. Loesch

Individual

08/31/2022

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.	Lawrence F. Loesch Individual 08/31/2022

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.

Lawrence F. Loesch

Individual

08/31/2022

(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

Facility ID's and Call Signs of all stations with whom the transmitter is shared.

Primary Transmitter

New Transmitter Costs

Primary Transmitter

Other Transmitter Costs

Primary Transmitter

Other Transmitter Cost Not Listed

Antennas

Transmission Line

Tower Equipment And Rigging Costs

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

Cost Information

Transmission Line

Cost Information

Tower Equipment and Rigging Costs

Cost Information

Outside Professional Services

Components

Cost Information

Other Expenses

Components

Cost Information

Grand Total

Reimbursement Status

Certification

Certification

Certification

Attachments