Form FCC Form 421-IB FCC Form 421-IB Application for an International Broadcast Station Licen

Federal Communications Commission Washington, D.C. 20554

FCC 420-IB APPLICATION FOR AUTHORITY TO CONSTRUCT OR MAKE CHANGES IN AN INTERNATIONAL BROADCAST STATION

Approved by OMB 3060-1056

For Commission Use Only File No.

Section I

1. Name of Applicant

2. Name and address of person to whom communications should be sent, if different from applicant.

Street Address

Street Address

City

State

ZIP Code

City

State

ZIP Code

Telephone (include area code)

FCC Registration Number

Telephone (include area code)

3. Purpose of Application (check appropriate boxes)

(a) Application is for :

New Station

Change in existing authorization

Major

Minor

(b)

If this application is for a change in existing facilities, complete Section 1 plus any other Sections necessary to show all substantial changes in information previously filed with the Commission. Indicate below the Sections completed and filed with this application.

Section II

Section III

Section IV

Section V

Section VI

(c)

In the space below refer to information already on file with the Commission which, in accordance with Instruction E, may be incorporated in this application by proper reference.

File or Form No. and Date

Section No.

Paragraph No.

4. Requested Facilities

Frequency (not applicable to International Stations)

Antenna Input Power

Hours of Operation

Call Sign

Type of Station:

International

Experimental

Experimental Facsimile

Developmental broadcast station

Location of Main Studio

Street Address

City

State

ZIP Code

FCC 420-IB INSERT DATE

5.

Application for facilities other than international broadcast stations signify their understanding that:

(1)

All operation upon the frequency requested is for experimental purposes only;

Yes No

(2)

The frequency requested may not be the best suited to the particular experimental work to be carried on;

Yes No

(3)

The frequency requested may not be allocated for any service that may be developed as a result of the experimental operation;

Yes No

(4)

Any frequency which may be assigned is subject to change without prior notice or right to hearing; and

Yes No

(5)

Any authorization issued pursuant to the application may be modified or withdrawn at any time without prior notice or right to hearing.

Yes No

6.

By checking “Yes,” THE APPLICANT confirms its understanding that it hereby waives any claim to the use of any particular frequency or of the electromagnetic spectrum as against the regulatory power of the United States because of the previous use of the same, whether by license or otherwise, and requests an authorization in accordance with this application. (See Section 304 of the Communications Act of 1934, as amended.)

Yes No

7.

By checking “Yes,” THE APPLICANT confirms its understanding that it represents that this application is not filed for the purpose of impeding, obstructing, or delaying determination on any other application with which it may be in conflict.

Yes No

8.

The applicant certifies that neither applicant nor any party to this application, nor any party directly or indirectly controlling your company, is subject to denial of federal benefits pursuant to Section 5301 of the Anti-Drug Abuse Act of 1988, 21 U.S.C. Section 862.

Yes No

THE APPLICANT acknowledges that all the statements made in this application and attached exhibits are considered material representations, and that all the exhibits are a material part hereof and are incorporated herein as it set out in full in the application.

Certification

I certify that the statements in this application are true, complete, and correct to the best of my knowledge and belief, and are made in good faith.

Date

Title of Person Signing

Name of Applicant

Signature

WILLFUL FALSE STATEMENTS ON THIS FORM ARE PUNISHABLE BY FINE AND/OR IMPRISONMENT (U.S. CODE, TITLE 18, SECTION 1001), AND/OR REVOCATION OF ANY STATION LICENSE OR CONSTRUCTION PERMIT (U.S. CODE, TITLE 47, SECTION 312(a)(1)), AND/OR FORFEITURE (U.S. CODE, TITLE 47, SECTION 503).

FCC 420-IB (Page 2) INSERT DATE

Section II – LEGAL QUALIFICATIONS

Name of Applicant

1. Legal Identity of application (check appropriate box)

Individual

Partnership

Corporation

Government Entity

Other (specify)

2.

Do you certify that you are not a foreign government or a representative of a foreign government?

Yes No

3.

Do you certify that you are not an alien, or the representative of an alien?

Yes No

4.

Do you certify that your are not a corporation organized under the laws of any foreign government?

Yes No

5.

Do you certify that your are not a corporation of which more than one-fifth of the capital stock is owned of record or voted by aliens or their representatives or by a foreign government or representative thereof, or by any corporation organized under the laws of a foreign country?

Yes No

6.

Do you certify that you are not corporation directly or indirectly controlled by any other corporation of which more than one-fourth of the capital stock is owned of record or voted by aliens, their representatives, or by a foreign government or representative thereof, or by any corporations organized under the laws of a foreign country?

Yes No

If the answer to any of Questions 2-6 is “No,” submit as an Exhibit the ownership information required by 47 C.F.R. Section 73.3555. The Exhibit must contain the following items: (1) An identification of the aliens or foreign entities; (2) Nationality of the aliens or foreign entities; (3) Relationship of the aliens or foreign entities to the applicant; and (4) Percentage of stock owned or voted by the aliens or foreign entities.

Exhibit No.

7.

Do you certify that the applicant or any party to the application has NOT had any FCC station authorization or license revoked or had any application for an initial, modification or renewal of FCC station authorization, license or construction permit denied by the Commission?

Yes No

If “No,” submit as an Exhibit an explanation.

Exhibit No.

8.

Do you certify that neither applicant nor any party to this application, nor any party directly or indirectly controlling your company, has EVER been convicted of a felony by any state or federal court?

Yes No

If “No,” submit as an Exhibit an explanation.

Exhibit No.

9.

Do you certify that NO court has finally adjudged the applicant, or any person directly or indirectly controlling the applicant, guilty of unlawfully monopolizing or attempting to monopolize radio communications, directly or indirectly, through control of manufacture or sale of radio apparatus, exclusive traffic arrangement or any other means of unfair methods of competition?

Yes No

If “No,” submit as an Exhibit an explanation.

Exhibit No.

10.

Do you certify that neither you nor any person directly or indirectly controlling the applicant, is not currently a party in any pending matter referred to in Questions 8 and 9.

Yes No

If “No,” submit as an Exhibit an explanation.

Exhibit No.

FCC 420-IB (Page 3) INSERT DATE

Section III – FINANCIAL QUALIFICATIONS

Name of Applicant

FOR COMMISSION USE ONLY File No.

NOTE: If this application is for a change in an operating facility do not fill out this section

1.

The applicant certifies that it has sufficient net liquid assets on hand or available from committed sources to construct and operate the requested facilities for three months without revenue.

Yes No

2.

The applicant certifies that it has a reasonable assurance of a present firm intention for each agreement to furnish capitol or purchase capitol stock by parties to the application, each loan by banks, financial institutions or others, and each purchase of equipment on credit.

Yes No

3.

The applicant can and will meet all contractual requirements as to collateral, guarantee, and capital investment.

Yes No

4.

The applicant has determined that a reasonable assurance exists that all such sources (excluding banks, financial institutions, and equipment manufacturers) have sufficient net liquid assets to meet these commitments.

Yes No

Section IV - STATEMENT OF PROGRAM SERVICE OF BROADCAST APPLICANT

1.

If programs are to be broadcast, submit as an Exhibit an outline of the program plans and policies.

Exhibit No.

2.

Research program (not applicable to international stations)

Attach as an Exhibit a statement outlining in detail the program of research and experimentation proposed and the object or objects thereof including therein a statement that upon authorization the applicant can and will proceed immediately with the proposed program, that the transmission of signals by radio is essential to the proposed program of research and experimentation, that the program of research and experimentation will be conducted by qualified personnel. Include as a separate Exhibit names and qualifications and an estimate of the period of time which will be required to complete the experimental program and terminate operation. If the transmission of broadcast program material is proposed, supply details as to the source of such program material and explicitly the reasons why the data sought cannot be obtained through the use of an unmodulated carrier, pulses, tones, or test patterns. If public participation is proposed to be sought, state the need therefore.

Exhibit No.

Exhibit No.

Section V - EQUAL EMPLOYMENT OPPORTUNITY PROGRAM

If the applicant proposes to employ five or more full-time employees, applicant certifies that it is filing simultaneously with this application a Model EEO Program Report on FCC Form 396-A.

Yes No

FCC 420-IB (Page 4) INSERT DATE

Section VI - ENGINEERING DATA

Name of Applicant

1.

Purpose of authorization applied for: (check appropriate box)

Construct a new station

Modify an existing authorization (Specify)

2.

Facilities requested

FREQUENCY 1/

POWER 2/

NECESSARY BANDWIDTH (KHZ)

TYPE OF EMISSION 3/

1/ International Broadcast Station applicants need not specify frequency.

2/ For amplitude modulation television (AS), give maximum antenna input power during synchronizing pulses. If particulars are not fully described above, such as aural and visual carrier frequencies and power for television and type of emission, etc., supply this information in an Exhibit. Developmental stations using amplitude modulation or frequency modulation, give unmodulated antenna input power. For other types of emission, give a full description of method of determining power as an Exhibit. Describe in an Exhibit the means which will be used for determining and maintaining power output of the transmitter to the values specified.

Exhibit No.

Exhibit No.

Exhibit No.

3/ See Part 2 of the Commission’s Rules and Regulations.

3.

Proposed transmitter location

Number or Street (or other indication of location

State

County

City

Geographical Coordinates (to be determined to nearest second) of the proposed antenna structure

NORTH LATITUDE

WEST LONGITUDE

4.

Attach as an Exhibit a map(s) (topographic where obtainable, such as U.S. Geological Survey quadrangles) for the area within 15 miles of the proposed transmitter location and show drawn thereon the following data: (1) Proposed transmitter location – accurately plotted. (2) Transmitter location and call signs of all known radio stations (except amateur) and the location of known commercial and government receiving stations within 2 miles of the proposed transmitter location.

Exhibit No.

5.

Transmitting apparatus to be installed

ANTENNA MAKE & MODEL

MANUFACTURER

TYPE NO.

Rated Unmodulated Carrier Power Output

(If the above transmitter(s ) is/are composite or of a type for which data has not been filed with the FCC, attach as an Exhibit a complete technical description of the transmitter(s) and auxiliary equipment with functional (block) diagrams indicating tube complements and the operating constants of the last radio stage. Include also auxiliary radio frequency equipment such as multiplexing networks, sideband filters, etc. If experimental program is likely to make major changes necessary, indicate the tentative arrangement contemplated indicating those portions which are subject to change.)

Exhibit No.

FCC 420-IB (Page 5) INSERT DATE

6.

Have you registered your structure(s) with the FCC?

Yes No

If “No” to Question 6, can you certify that FAA notification is not required under 47 C.F.R. Part 17 and 47 C.F.R. Section 25.113(c)?

Yes No

If “Yes” attach a certification as an Exhibit.

Exhibit No.

7.

If applicant has registered structure with the FCC, enter an antenna structure registration number for each antenna.

8.

Transmission line proposed to supply power to the antenna from the transmitter.

Make

Type No.

Description

Size in Inches (nominal inside transverse dimension

Length in meters

Rate efficiency in percent for this length

Antenna Structure

9.

The applicant certifies that the proposed construction is in the immediate vicinity or does it serve to modify the construction of any AM, FM or television broadcast station, or other class of radio station?

Yes No

If “Yes,” submit as an Exhibit complete engineering data thereon.

Exhibit No.

10.

Submit as an Exhibit a vertical plan sketch for the proposed total structure (including supporting buildings, if any) giving heights above ground in feet for all significant features.

Exhibit No.

11.

Overall height in feet above ground. (Do not include the height of any obstruction lighting which may be required.)

12.

Overall height in feet above mean sea level. (Do not include the height of any obstruction lighting which may be required.

13.

Antenna data. (Applicants for international broadcasting stations should submit all pertinent data regarding antenna characteristics in accordance with the requirements of the International Telecommunications Union & Radio Regulations.)

Make

Type No. or Description

Number of Sections

Antenna Power Gain

14.

During the course of experimentation, will the antenna system be changed?

Yes No

If “Yes,” attach as an Exhibit the changes or modifications contemplated.

Exhibit No.

15.

Is a directional antenna proposed?

Yes No

If “Yes,” attach as an Exhibit complete engineering data thereon.

Exhibit No.

16.

Frequency or percentage of modulation measurement.

Method of measuring or monitoring station frequency

Method of measuring or monitoring station modulation

FCC 420-IB (Page 6) INSERT DATE

17.

Environmental Statement. Would a Commission grant of your application be a major action as defined by 47 C.F.R. Section 1.1305?

Yes No

If “Yes,” attach as an Exhibit the required statement in accordance with 47 C.F.R. 1.311.

Exhibit No.

If “No,” provide a brief explanation as an Exhibit.

Exhibit No.

18.

Is the proposed site the same or immediately adjoining the transmitter antenna site of other stations authorized by the Commission or specified in another application pending before the Commission?

Yes No

If “Yes,” provide call sign.

19.

Features of surrounding terrain. Attach as an Exhibit a chart on which is plotted the exact location of the antenna site and also the relative location and height of any natural formation or existing man-made structures (trees, tanks, water towers, buildings, etc.) which, in the opinion of the applicant would tend to shield the antenna from aircraft. The chart used shall be a 7.5 or 15 minute series topographic quadrangle (choice depending upon proximity of the antenna site to landing areas) or a full scale photo copy. On the chart include (1) a scale of miles, (2) sufficient latitude and longitude lines, clearly labeled, so that the location of sites may be verified, and (3) all identifying map information. These charts may be purchased from the U.S. Geographical Survey (Exception – where the proposed antenna site is within the boundary of landing areas, submit a self-made, large scale map showing antenna site runways and existing man-made structures).

Exhibit No.

20.

List all landing areas within 10 miles of antenna site. Give distance and direction to the nearest boundary of each landing area from the antenna site.

Landing Area

Distance

Direction

21.

Attach as an Exhibit a description of antenna system (if directional, give spacing and orientation of towers) using the following data: type, description of tower, self supporting, guyed, tubular pole.

Exhibit No.

Tower (height figures should include obstruction lighting)

#1

#2

#3

#4

#5

Height of radiating antenna

Overall height above ground

Overall height above mean sea level

22.

If a combination of AM, FM or TV operation is proposed on the same multi-element array (either existing or proposed), submit as an Exhibit a horizontal plan for the proposed antenna system, giving heights of the elements above ground and showing their orientation and spacing in feet. Clearly indicate if any towers are in existence.

Exhibit No.

23.

Submit as an Exhibit a vertical plan sketch for the proposed total structure (including supporting structures, if any) giving heights above ground in feet for all significant features. Clearly indicate existing portions, noting lighting, and distinguish between the skeletal or other main supporting structure and the antenna elements.

Exhibit No.

I certify that I represent the applicant in the capacity indicated below and that I have examined the foregoing statement of technical information and that it is true to be best of my knowledge and belief.

Date

Signature

Check appropriate box

Technical Director

Chief Operator

Registered Professional Engineer

Consultant

FCC 420-IB (Page 7) INSERT DATE