Form 159

0104-EX-ML-2012 Post Grant Documents

xG Technology Inc.

2012-07-10ELS_127355

USBANK/FOC JUN26?O1 ca7?qJt1 o( READ INSTRUCTIONS CAREFULLY Approved by 0MB / BEFORE PROCEEDING FEDERAL COMMUNICATIONS COMMISSION 3060-0589 REMITTANCE ADVICE Page Nol of 1 (I)LOCKBOX^^ SPECIAL USE ONLY 979095 FCCUSEONLY SECTION A- PAYER INFORMATION (2) PAYER NAME (if paying by credil card enter name exactly as it appears on the card) (3) TOTAL AMOUNT PAID (U.S. Dollars and cents) Blooston, Mordkof sky, Dickens, Duffy & Prendergast $60.00 (4) STREET ADDRESS LINE NO. 2120 L Street, N.W. (5) STREET ADDRESS LINE NO, Suite 300 (6SCITY (7)STATE (8)ZIPCODE 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 (FRN) REQUIRED (It) PAYER (FRN) (t2) FCC USE ONLY 0003714193 IF MORE THAN ONE APPLICANT, USE CONTINUATION SHEETS (FORM 159-C) COMPLETE SECTION BELOW FOR EACH SERVICE, IF MORE BOXES ARE NEEDED, USE CONTINUATION SHEET (13) APPLICANT NAME xG Technology Inc. (14) STREET ADDRESS LINE NO. Joseph Bobier (15) STREET ADDRESS LINE NO.2 7771 W. Oakland Park Blvd., Suite 231 (t6)CITY (17)STATE (tS)ZIPCODE Sunrise FL 33351 -6796 (19) DAYTIME TELEPHONE NUMBER (include area code) (20) COUNTRY CODE (if not in U.S.A.) xx FCC REGISTRATION NUMBER (FRN) REQUIRED (21)APPLICANT(FRN) (22) FCC USE ONLY 0011412939 COMPLETE SECTION C FOR EACH SERVICE, IF MORE BOXES ARE NEEDED, USE CONTINUATION SHEET (23A) CALL SIGN/OTHER ID (24A) PAYMENT TYPE CODE (25A) QUANTITY 0104ML2012 EAE 1 (26A) FEE DUE FOR (FTC) ' (27A) TOTAL FEE FCC USE ONLY $60.00 $60.00 (28A) FCC CODE I (29A) FCC CODE 2 13EL939410 (23B) CALL SIGN/OTHER ID (24B) PAYMENT TYPE CODE (25B) QUANTITY (26B) FEE DUE FOR (FTC) (27B) TOTAL FEE FCC USE ONLY (28B)FCC CODE I (29B) FCC CODE 2 SECTION D- CERTIFICATION CEIIFICATIO04 STA,EMENT - I,: O 1+ A-i A / / ' tAJP (. R 1 fy under penalty ofperjury that the foregoing and supporting information is true and correcl to the heal ofmy knowfedke, info lion and belie SIGNATURE 2_C DATE _____________ CTION E - CREDIT CARD PAYMENT INFORMATION MASTER'ARD VISA AMEX DISCOVER ACCOUNT NUMBER_________________________________________ EXPIRATION DATE ____________________________ thereby authorize the FCC to charge my credit cord for the service(s)/aulhorizaticn herein described. SIGNATURE_________________________________________________________ DATE____________________________ SEE PUBLIC BURDEN ON REVERSE FCC FORM 159 FEBRUARY 2003(REVtSED)


Document Created: 2012-07-10 12:00:31
Document Modified: 2012-07-10 12:00:31
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