Application Form ROA-NEW-INTR2009-02067

Application Form

This document pretains to ROA-NEW-INTR2009-02067 for New Application on a Recognized Operating Authority filing.

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

ILLINOIS LOTTERY

1. Applicant

Name:	ILLINOIS LOTTERY, http	Phone Number:	224-356-4947
DBA Name:		Fax Number:	224-356-4947
Street:	PO BOX 1112	E-Mail:	[email protected]

City:	WOODSTOCK	State:	IL
Country:	USA	Zipcode:	60098 -1112
Attention:	Ms BRAIN GAYLORD

2. Contact

Name:	BRAIN GAYLORD	Phone Number:	224-356-4947
Company:	BRAIN BRAIN	Fax Number:	224-356-4947
Street:	PO BOX 1112	E-Mail:	[email protected]

City:	WOODSTOCK	State:	IL
Country:	USA	Zipcode:	60098 -1112
Attention:	BRAIN BRAIN	Relationship:	Same

3. Other Company(ies) Involved in Application

STATE OF ILLINOIS

4. Destination Country USA

5. Place of Incorporation STATE OF ILLINOIS

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):

7. Attachment 1: FCN

Attachment 2:

Attachment 3:

8. Is the agency an Enhanced Service Provider?

Yes

9. Is the agency a Common Carrier?

Yes

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 63.701)?

Yes

12. I am aware that my company is bound by all laws and obigations of the United States, including Article 6 of the Constition of the International Telecommunications Union and all binding telecommunications regulations promulgated thereunder. My company will obey those abilgations in all respects.

Yes

FOREIGN AFFILIATION

13. Affiliation (a): A greater than 25 percent ownership of capital stock, or controlling interest at any level, by the 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.

Yes

14. Affiliation (b): A greater than 25 percent ownership of capital stock, or controlling interest at any level, in the 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.

Yes

BASIC QUALIFICATIONS

15. By checking Yes, the undersigned certifies, that neither applicant nor any other party to the application is subject 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.

Yes

16. Description. (Summarize the nature of the application and the services to be provided). CARRIER

CERTIFICATION
17. Typed Name of Person Signing BRAIN GAYLORD	18. Title of Person Signing CARRIER
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 5 hours 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 estim ate, or how we can improve the collection and reduce the burden it causes you, please write to the Federal Comm unications Commission, AMD-PERM, Paperwork Reduction Project (3060-0357), Washington, DC 20554. We will also a ccept your comments regarding the Paperwork Reduction Act aspects of this collection via the Internet if you se nd 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 numbe r of 3060-0357.

THE FOREGOING NOTICE IS REQUIRED BY THE PAPERWORK REDUCTION ACT OF 1995, PUBLIC LAW 104-13, OCTOBER 1, 1 995, 44 U.S.C. SECTION 3507.