Application Form [pdf]

This document pretains to ROA-NEW-20170215-00001 for New Application on a Recognized Operating Authority filing.

IBFS_ROANEW2017021500001_1187177

Approved by OMB 3060−0357 RECOGNIZED OPERATING AGENCY FILING FOR OFFICIAL USE ONLY APPLICANT INFORMATION Enter a description of this application to identify it on the main menu 7174 1. Applicant Name: marie davis Phone Number: 6468200651 DBA Name: Drake Fax Number: Street: 280 commerce cir E−Mail: Itsms546@gmail.com City: sacramento State: CA Country: USA Zipcode: 95814 − Attention: marie l davis 1

2. Contact Name: Marie Davis Phone Number: 6468200651 Company: 1984 Fax Number: Street: 280 commerce cir E−Mail: itsms546@gmail.com City: sacramento State: CA Country: USA Zipcode: 95814 − Attention: Relationship: 3. Other Company(ies) Involved in Application Cbs 4. Destination Country USA 5. Place of Incorporation Ca 6. Is a fee submitted with this application? If Yes, complete and attach FCC Form 159. If No, indicate reason for fee exemption (see 47 C.F.R.Section 1.1114). Governmental Entity Noncommercial educational licensee Other(please explain): Grant 2

7. Attachment 1: Reference Attachment 2: FCC Attachment 3: Nra 8. Is the agency an Enhanced Service Provider? Yes No 9. Is the agency a Common Carrier? Yes No 10. If you answered "Yes" to questions 8 or 9, please check if required attachments are included in the filing. Yes No N/A 11. Operator of radio frequency equipment capable of causing harmful interference internationally (Rule Part Yes No 63.701)? 12. I am aware that my company is bound by all laws and obigations of the United States, including Article 6 of Yes No the Constition of the International Telecommunications Union and all binding telecommunications regulations promulgated thereunder. My company will obey those abilgations in all respects. 3

FOREIGN AFFILIATION 13. Affiliation (a): A greater than 25 percent ownership of capital stock, or controlling interest at any level, by the Yes No applicant, or by any entity that directly or indirectly controls or is controlled by it, or that is under direct or indirect common control with it, in a foreign carrier or in any entity that directly or indirectly controls a foreign carrier. 14. Affiliation (b): A greater than 25 percent ownership of capital stock, or controlling interest at any level, in the Yes No applicant by a foreign carrier, or any entity that directly or indirectly controls or is controlled by a foreign carrier, or that is under direct or indirect common control with a foreign carrier; or by two or more foreign carriers investing in the applicant in the same manner in circumstances where the foreign carriers are parties to, or the beneficiaries of a contractual relation. BASIC QUALIFICATIONS 15. By checking Yes, the undersigned certifies, that neither applicant nor any other party to the application is subject Yes No to a denial of Federal benefits that includes FCC benefits pursuant to Section 5301 of the Anti−Drug Act of 1988, 21 U.S.C. Section 862, because of a conviction for possession or distribution of a controlled substance. See 47 CFR 1.2002(b) for the meaning of "party to the application" for these purposes. 4

16. Description. (Summarize the nature of the application and the services to be provided). (If the complete description does not appear in this box, please go to the end of the form to view it in its entirety.) Radio air play CERTIFICATION 17. Typed Name of Person Signing 18. Title of Person Signing Marie davis Licensee 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). 5

FCC NOTICE REQUIRED BY THE PAPERWORK REDUCTION ACT The public reporting for this collection of information is estimated to average 5 hours per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the required data, 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 (3060−0357), 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 PRA@fcc.gov. 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 3060−0357. 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. 6


Document Created: 2019-04-10 13:41:03
Document Modified: 2019-04-10 13:41:03
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