Application Form

This document pretains to ARC-MOD-20170216-00001 for Modification on a Accounting Rate Change filing.

Approved by OMB 3060-0454

FEDERAL COMMUNICATIONS COMMISSION APPLICATION FOR AN ACCOUNTING RATE CHANGE FOR OFFICIAL USE ONLY

APPLICANT INFORMATION

Enter a description of this application to identify it on the main menu:

Rate change

1. Applicant Name: marie davis Phone Number: -- DBA Name: Drake Fax Number: Street: 280 commerce cir E-Mail: [email protected] City: sacramento State: CA Country: USA Zipcode: 95814 - Attention: A. Graham

2. Contact Name: ksfm 102.5 Phone Number: -- Company: Fax Number: Street: 280 commerce cir E-Mail: [email protected] City: sacramento State: CA Country: USA Zipcode: 95814 - Attention: Relationship:

3. Application Type: Modification of Existing Accounting Rate Petition for Declaratory Ruling

4. U.S. Carrier: FC 3 kw of equal applicable fee 5. Foreign Carrier: FM broadcast 6. Foreign Point Being Served: USA

7. 1: LOC 2: Fee 3: Reference

SERVICE INFORMATION S1. U.S. Carrier: FC 3 kw of equal applicable fee S2. Foreign Carrier: FM broadcast S3. Foreign Point Being Served: USA

S4. Service: AC

S5. Current Rate: 423,000 S6. New Rate: 666,000 S7. Surcharge: 2

S8. Effective Date: 01/30/2017 S9. Expire Date: 01/30/2026

S10. [50/50]: Yes No S11. Proportionate Return: Yes No

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 AUTHORIZATION (U.S. Code, Title 47, Section 312(a)(1)), AND/OR FORFEITURE (U.S. Code, Title 47, Section 503).

FCC NOTICE REQUIRED BY THE PAPERWORK REDUCTION ACT The public reporting for this collection of information is estimated to average 1 hour per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the required d ata, and completing and reviewing the collection of information. If you have any comments on this burden estimate, or how we can improve the collection and reduce the burden it causes you, please write to the Federal Communications Commission, AMD-PERM, Paperwork Reduction Project (3060-0454), Washington, DC 20554. We will also accept your comments regarding the Paperwork Reduction Act aspects of this collection via the Internet if you send them to [email protected]. PLEASE DO NOT SEND YOUR RESPONSE TO THIS ADDRESS. Remember - You are not required to respond to a collection of information sponsored by the Federal government, and the government may not conduct or sponsor this collection, unless it displays a currently valid OMB control number or if we fail to provide you with this notice. This collection has been assigned an OMB control number of 3060-0454. THE FOREGOING NOTICE IS REQUIRED BY THE PAPERWORK REDUCTION ACT OF 1995, PUBLIC LAW 104-13, OCTOBER 1, 1995, 44 U.S.C. SECTION 3507.