Payment confirmation

0360-EX-CN-2019 Text Documents

ELTA North America

2019-04-30ELS_228793

4/30/2019 FCC:Success:Form 159 - PRINTABLE VERSION Agency Tracking ID:PGC3240629 Authorization Number:273233 Successful Authorization -- Date Paid: 4/30/19 FILE COPY ONLY!! READ INSTRUCTIONS FEDERAL COMMUNICATIONS COMMISSION APPROVED BY OMB CAREFULLY BEFORE PROCEEDING REMITTANCE ADVICE SPECIAL USE 3060-059 FORM 159 PAGE NO 1 OF 1 FCC USE ONLY (1) LOCKBOX #979095 SECTION A - Payer Information (3) TOTAL AMOUNT PAID (dollars and cents) (2) PAYER NAME (if paying by credit card, enter name exactly as it appears on your card) $70.00 ELTA North America (4) STREET ADDRESS LINE NO. 1 11840 West Market Place (5) STREET ADDRESS LINE NO. 2 Suite A (6) CITY (7) STATE (8) ZIP CODE Fulton MD 20759-2075 (9) DAYTIME TELEPHONE NUMBER (INCLUDING AREA CODE) (10) COUNTRY CODE (IF NOT IN U.S.A.) 240-4591905 US FCC REGISTRATION NUMBER (FRN) AND TAX IDENTIFICATION NUMBER (TIN) REQUIRED (11) PAYER (FRN) (12) FCC USE ONLY 0021371521 IF PAYER NAME AND THE APPLICANT NAME ARE DIFFERENT, COMPLETE SECTION B IF MORE THAN ONE APPLICANT, USE CONTINUATION SHEETS (FORM 159-C) (13) APPLICANT NAME ELTA North America (14) STREET ADDRESS LINE NO. 1 Avraham Abasov (15) STREET ADDRESS LINE NO. 2 8955 Henkels Lane P.O. Box 20701 (16) CITY (17) STATE (18) ZIP CODE Annapolis Junction MD 20701 (19) DAYTIME TELEPHONE NUMBER (INCLUDING AREA CODE) (20) COUNTRY CODE (IF NOT IN U.S.A.) US FCC REGISTRATION NUMBER (FRN) AND TAX IDENTIFICATION NUMBER (TIN) REQUIRED (21) APPLICANT (FRN) (22) FCC USE ONLY 0021371521 COMPLETE SECTION C FOR EACH SERVICE, IF MORE BOXES ARE NEEDED, USE CONTINUATION SHEET (23A) FCC Call Sign/Other ID (24A) Payment Type Code(PTC) (25A) Quantity 0360CN2019 EAE 1 (26A) Fee Due for (PTC) (27A) Total Fee FCC Use Only $70.00 $70.00 (28A) FCC CODE 1 (29A) FCC CODE 2 13EL429164 (23B) FCC Call Sign/Other ID (24B) Payment Type Code(PTC) (25B) Quantity (26B) Fee Due for (PTC) (27B) Total Fee FCC Use Only (28B) FCC CODE 1 (29B) FCC CODE 2 https://pay.fcc.gov/ElectronicForm159/success_159_html/printed159_success.cfm 1/2

4/30/2019 FCC:Success:Form 159 - PRINTABLE VERSION https://pay.fcc.gov/ElectronicForm159/success_159_html/printed159_success.cfm 2/2


Document Created: 2019-04-30 17:07:40
Document Modified: 2019-04-30 17:07:40
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