Form 159

0100-EX-RR-2015 Post Grant Documents

xG Technology Inc.

2015-03-10ELS_159879

(JoZZ(tQ(J 6UbD1 rjs READ INSTRUCTIONS CAREFULLY Approved by 0MB BEFORE PROCEEDING FEDERAL COMMUNICATIONS COMMISSION 3060-0589 REMIUANCE ADVICE Page Nol of 1 (1)LOCKBOX6 SPECIAL USE ONLY 979095 FCCUSIONI.Y SECTION A - PAYER INFORMATION (2) PAYER NAME (if paying by credil card enter name exactly as it appears onthe card) (3) TOTAL ASINI NI l'.\tD (U S Dollars and cenls) Blooston, Mordkof sky, Dickens, Duffy & Prendergast $65.00 (4) STREET ADDRESS LINE NO.1 2120 L Street, N.W. (5) STREET ADDRESS LINE NO.2 Suite 300 (65 CITY (7) STATh (8) ZIP CODE Washington DC 20037 (9) DAYTIME TELEPHONE NUMBER (include area code) (10) COUNTRY CODE (if not in U.S.A.) 202-6590830 US FCC REGISTRATION NUMBER (FR7s) REQUJREI) (I 1)PAYERFRN) I 12) FCC USE ONI.Y 0003714193 IF MORE THAN ONE APPLICANT, USE CONTIN UArJoN SHEETS (FORM 159-C) COMPLETE SECTIONBELOV FOR EACH SERVICE. IF MORE BOXES ARE NEEDED. (SE coNrINuAlloN SHEET (13) APPLICANT NAME xG Technology Inc. (14) STREET ADDRESS LINE NO.1 George Schmitt (IS) STREET ADDRESS LINE NO.2 7771 W. Oakland Park Blvd., Suite 231 (16)CITY (17)STATE (18)ZIPCODE Sunrise FL 33351 -6796 (19) DAYTIME TELEPHONE NUMBER (include area code) (20) COUNTRY CODE (if not in U.S.A.) 202-828-5520 XX FCC REGISTRATION NLMJIER (FRN) REQUIRED (21) APPLICANT(FRN) t22) FCC USE ONLY 0011081403 COMPLETE SECTION C FOREACII SERVICE, IF MORE IIOXES ARE NEEDED, (SE CONTJM ATION SHEET (23A) CALL SIGN/OTHER ID (24A) PAYMENT TYPE CODE (25A) QUANTITY O100RR2O15 EAE 1 (26A) FEE DUE FOR (PTC) (27A) TOTAL FEE FCC IISE UNIV $65.00 $65.00 (2IA) FCC CODE I (29A) FCC CODE 2 13EL389977 (23B) CALL SIGN/OTHER ID (24B) PAYMENT TYPE CODE 125B) QUANTITY (26B) FEE DUE FDR (PTC) (27B) TOTAL FEE FtC USE ONLY (28B)FCC CODE I (29B) FCC CODE 2 SECTION B - CERTIFICATION CEREIFICATION STATEMENT7' i Lf-tarO 1(7 /7o certify under penally ofperjnry that the foregoing and supporting information is true and correct to the best of my knowled informati n and el f SIGNATS (. DATE __/ / MASTERCA SECT NE-CRE ITCARDPAYMENTINFORMATION V SA AMEX DISCOVER ACCOUNT NUMBER_______________________________________ EXPIRATION DATE __________________________ I hereby authorize the FCC 10 charge my credit card for the service(s)/authorizalico herein described. SIGNATURE___________________________________________________ DATh_________________________ SEE PUBLIC BURDEN ON REVERSE FCC FORM 159 FEBRUARY 2003(REVISED)


Document Created: 2015-03-10 12:02:19
Document Modified: 2015-03-10 12:02:19
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