THE APPLICANT CERTIFIES THAT:
THE APPLICANT FURTHER CERTIFIES THAT:
- Copies of the FCC Rule Parts 2 and 5 are on hand; and
- Adequete financial appropriations have been made to carry on the
program of experimentation which will be conducted by qualified personnel;
- All operations will be on an experimental basis in accordance with
Part 5 and other applicable rules, and will be conducted in such a manner
and at such a time as to preclude harmful interference to any authorized
- Grant of the authorization requested herein will not be construed
as a finding on the part of the Commission:
- that the frequencies and other technical parameters specified
in the authorization are the best suited for the proposed program
of experimentation, and
- that the applicant will be authorized to operate on any basis
other than experimental, and
- that the Comission is obligated by the results of the experimental
program to make provision in its rules including its table of frequency
allocations for applicant's type of operation on a regularly licensed
- All the statements in the application and attached exhibits are true,
complete and correct to the best of the applicant's knowledge; and
- The applicant is willing to finance and conduct the experimental
program with full knowledge and understanding of the above limitations;
- The applicant waives any claim to the use of any particular frequency
or of the electromagnetic spectrum as against the regulatory power of
Name of Applicant:
Signature (Authorized person filing form):
Signature Date (Authorized person filing form):
Title of Person Signing Application:
Wireless Regulatory Engineer
WILLFUL FALSE STATEMENTS
MADE 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).
NOTIFICATION TO INDIVIDUALS UNDER PRIVACY ACT OF 1974 AND THE PAPERWORK REDUCTION ACT OF 1980
Information requested through this form is authorized by the Communications Act of 1934, as amended, and specified by Section 308 therein. The information will be used by Federal Communications Commission staff to determine eligibility for issuing authorizations in the use of the frequency spectrum and to effect the provisions of regulatory responsibilities rendered by the Commission by the Act. Information requested by this form will be available to the public unless otherwise requested pursuant to 47 CFR 0.459 of the FCC Rules and Regulations. Your response is required to obtain this authorization.
Public reporting burden for this collection of information is estimated to average four (4) hours per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing the burden to the Federal Communications Commission, Records Management Branch, Paperwork Reduction Project (3060-0065), Washington DC 20554. DO NOT send completed applications to this address. Individuals are not required to respond to this collection unless it displays a currently valid OMD control number.
THE FOREGOING NOTICE IS REQUIRED BY THE PRIVACY ACT OF 1974, P.L. 93-579, DECEMBER 31, 1974, 5 U.S.C. 552a(e)(3), AND THE PAPERWORK REDUCTION ACT OF 1980, P.L. 96-511, DECEMBER 11, 1980, 44 U.S.C. 3507.