Application Fee Receipt

0042-EX-ML-2013 Text Documents

Insitu

2013-03-07ELS_134227

FCC:Success:Form 159 — PRINTABLE VERSION Page 1 of 1 (~——> l ! 1 | /3 /XI U | J : ‘/ ; /4 /f'y/: Agency Tracking ID:PGC2288045 Authorization Number:065973 Successful Authorization —— Date Paid: 3/4/13 FILE COPY ONLY!! READ INSTRUCTIONS FEDERAL COMMUNICATIONS COMMISSION APPROVED BY OMB |CAREFULL Y BEFORE REMITTANCE ADVICE 3060—059 PROCEEDING FORM 159 PAGE NO 1 OF 1 preqIiADUOL 1) LOCKBOX #979095 ECC USE ONLY SECTION A — Payer Information 2) PAYER NAME (if paying by credit card, enter name exactly as it appears on your card) 2) TOTAL AMOUNT FAID (dollars and cents) [The Insitu Group $60.00 4) STREET ADDRESS LINE NO. 1 118 East Columbia River Way 5) STREET ADDRESS LINE NO. 2 6) CITY 7) STATE 8) ZIP CODE [Bingen WA 98605 9) DAYTIME TELEPHONE NUMBER (INCL UDING AREA CODE) 0) COUNTRY CODE (IF NOT IN U.S.A.) 509—4938600 S FCC REGISTRATION NUMBER (FRN) AND TAX IDENTIFICATION NUMBER (TIN) REQUIRED 11) PAYER (FRN) 12) FCC USE ONLY 0006843577 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 lInsitu 14) STREET ADDRESS LINE NO. 1 I(Ben Schreffier 15) STREET ADDRESS LINE NO. 2 118 East Columbia River Way 16) CITY 17) STATE |(18) ZIP CODE |Bingen WA 98605 19) DAYTIME TELEPHONE NUMBER (INCLUDING AREA CODE) 20) COUNTRY CODE (IF NOT IN U.S.A.) XX FCC REGISTRATION NUMBER (FRN) AND TAX IDENTIFICATION NUMBER (IIN) REQUIRED 21) APPLICANT (FRN) 22) FCC USE ONLY 0006843577 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 0042 ML2013 EAE 1 26A) Fee Due for (PTC) 27A) Total Fee FCC Use Only $60.00 $60.00 28A) FCC CODE 1 29A) FCC CODE 2 13EL404500 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.fce.gov/ElectronicForm159/success 159 html/printed159 success.cfm 3/4/2013


Document Created: 2018-12-07 03:41:48
Document Modified: 2018-12-07 03:41:48
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