Application Form

This document pretains to ROA-NEW-INTR2021-03062 for New Application on a Recognized Operating Authority filing.

Approved by OMB
3060-0357
RECOGNIZED OPERATING AGENCY FILING
FOR OFFICIAL USE ONLY
APPLICANT INFORMATION

1. Applicant
PSAP 8017993000
475 South 300 East [email protected]
SALT LAKE City UT
USA 84114 -
MARIE DAVIS
2. Contact
MARIE DAVIS 13108493157
FEDERAL BUREAU PF INVESTIGATION
475 South 300 East [email protected]
[email protected]
SALT LAKE City UT
USA 84114 -
3. Other Company(ies) Involved in Application



WELLS FARGO
USA UTAH
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: Lust Attachment 2: Space to earth Attachment 3: E
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 63.701)? Yes No
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 No
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 No
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 No
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 No
CIA
CERTIFICATION

MARIE DAVIS

Intelligence
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).



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