Form FCC Form 603 FCC Form 603 FCC Application for Assignment of Authorization or Trans

FCC Form 603	FEDERAL COMMUNICATIONS COMMISSION	Not Approved by OMB
		3060 -0800
	Information and Instructions	Est. Avg. Burden
		Per Response: 1.75 Hrs

FCC Application for Assignments of Authorization or Transfers of Control:

Wireless Telecommunications Bureau and Public Safety Homeland Security Bureau

NOTICE TO INDIVIDUALS REQUIRED BY THE PRIVACY ACT OF 1974 AND THE PAPERWORK REDUCTION ACT OF 1995

We have estimated that each response to this collection of information will take on average 1.75 hours. Our estimate includes the time to read the instructions, look through existing records, gather and maintain required data, and actually complete and review the form or response. If you have any comments on this estimate, or on how we can improve the collection and reduce the burden it causes you, please write the Federal Communications Commission, AMD-PERM, Washington, DC 20554, Paperwork Reduction Project (3060-0800). We will also accept your comments via the Internet if you send them to [email protected]. Please do not send completed application forms to this address.

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 with this notice. This collection has been assigned OMB control number 3060-0800.

The FCC is authorized under the Communications Act of 1934, as amended, to collect the personal information we request in this form. We will use the information you provide to determine whether approving this application is in the public interest. If we believe there may be a violation or potential violation of a statute, FCC regulation, rule or order, your application may be referred to the Federal, state, or local agency responsible for investigating, prosecuting, enforcing, or implementing the statute, rule, regulation, or order. In certain cases, the information in your application may be disclosed to the Department of Justice or a court or adjudicative body when (a) the FCC; or (b) any employee of the FCC; or (c) the United States Government, is a party to a proceeding before the body or has an interest in the proceeding.

All parties and entities doing business with the Commission must obtain a unique identifying number called the FCC Registration Number (FRN) and supply it when doing business with the Commission. Failure to provide the FRN may delay the processing of the application. This requirement is to facilitate compliance with the Debt Collection Improvement Act of 1996 (DCIA). The FRN can be obtained electronically from the FCC’s website at http://www.fcc.gov or by manually submitting FCC Form 160. FCC Form 160 is available from the FCC’s website at http://www.fcc.gov/formpage.html,

This notice is required by the Privacy Act of 1974, Public Law 93-579, December 31, 1974, 5 U.S.C. Section 552a(e)(3), and the Paperwork Reduction Act of 1995, Public Law 104-13, October 1, 1995, 44 U.S.C. 3507.

General Instructions

Purpose of Form

FCC Form 603 is a multi-purpose form. It is used to request approval for an Assignment of Authorization (Assignment) or Transfer of Control (Transfer) involving licenses in the Wireless Radio Services. This form is also used to provide notification of a consummated Assignment or Transfer that has previously been consented to by the FCC or for which notification but not prior consent is required. The data collected on the form is used by the FCC to determine whether the public interest would be served by approval of the requested Assignment or Transfer.

Each application, amendment, or other request must contain only one Main Form but may contain as few or as many of the optional schedules as necessary.

Main Form

The purpose of the Main Form is to obtain information sufficient to identify the parties to the proposed Assignment or Transfer, establish the parties' eligibility and qualifications for entering into the Assignment or Transfer, and classify the filing. The Main Form also contains the required certifications and signature blocks for both the Assignor/Transferor and the Assignee/Transferee. The Main Form is required with every filing.

(Note: The FCC Registration Number must be completed on the Main Form for all application purposes.)

Schedules

In addition to the Main Form, which is required with every filing, completion of certain schedule(s) may also be required. The purposes of the optional schedules are as follows:

Schedule A (Schedule for Licensees that Received Bidding Credits or Involving Licenses Won in Closed Bidding) This schedule establishes whether unjust enrichment provisions or other restrictions apply.

Schedule B (Schedule for Defined Geographic Areas To Be Partitioned or for Spectrum To Be Disaggregated) This schedule is used for Assignment applications in geographically-licensed services that involve partitioning of the licensed area or disaggregation of the licensed spectrum. This schedule must be used when the partitioned area involves FCC-defined geographic boundaries (i.e., FCC licensing boundaries (Major Trading Areas (MTAs), Basic Trading Areas (BTAs), etc.) or county boundaries.

Schedule C (Schedule for Undefined Geographic Areas To Be Partitioned) This schedule is used for Assignment applications in geographically-licensed services that involve partitioning of the licensed area when the partitioned area cannot be described using FCC-defined geographic boundaries or county boundaries. This schedule must be used to provide the geographic coordinates (latitude and longitude) that depict the periphery of the partitioned area.

Schedule D (Schedule for Notification of Consummation of an Assignment of Authorization or a Transfer of Control) This schedule is used to notify the FCC that a previously consented to Assignment or Transfer has been consummated.

Schedule E (Schedule for Request for Extension of Time To Consummate an Assignment of Authorization or a Transfer of Control) This schedule is used to request additional time to consummate a previously consented to Assignment or Transfer that the parties will not consummate in the time previously allotted to them by the FCC.

Types of Filings

Assignment of Authorization

An Assignment of Authorization involves a change in the identity of the holder of the License and generally entails the changing of the Licensee’s name. Designated Entities, as defined in Section 1.2110(a), must comply with Sections 1.2110 and 1.2111 when seeking to assign control of an authorization.

For an Assignment, the Assignor must request approval using FCC Form 603 and generally must receive prior consent (unless the Assignment is Involuntary or a post-consummation notification of a pro forma Assignment) from the FCC before assigning its authorization(s). For additional information regarding Assignments that can be filed without receiving prior consent from the FCC, see the sections titled Involuntary Transactions and Post-Consummation Notifications of Pro Forma Transactions.

Both the Assignor and Assignee must sign the form. In addition, if required pursuant to Section 1.919 of the Commission’s Rules, the Assignee must file FCC Form 602, FCC Ownership Disclosure Information for the Wireless Telecommunications Services, unless a current and up-to-date FCC Form 602 is already on file at the FCC. For information regarding the filing of FCC Form 602, see Sections 1.919, 1.2112 of the Commission’s Rules.

Full Assignment of Authorization

When the authorization for all of the facilities of a station or market is assigned, this is called a “Full” Assignment of Authorization. To apply for a full Assignment, the Assignor must complete the Authorizations To Be Assigned or Transferred section on the Main Form by providing the Call Sign and Radio Service Code for each of the authorizations that are being assigned.

Partial Assignment of Authorization

When the authorization for some, but not all, of the facilities of a station or market is assigned, this is called a “Partial” Assignment of Authorization.

To apply for a partial Assignment of a geographically-licensed authorization, the Assignor must complete the Authorizations To Be Assigned or Transferred section on the Main Form by providing the Call Sign and Radio Service Code for each of the authorizations that are being assigned as well as complete Schedule B and, if applicable, Schedule C.

To apply for a partial Assignment of a site-specific authorization, the Assignor must complete the Authorizations To Be Assigned or Transferred section on the Main Form by providing the Call Sign and Radio Service Code for each of the authorizations that are being assigned as well as complete other portions of the Authorizations To Be Assigned or Transferred section to fully describe the partial Assignment.

Transfer of Control

A Transfer of Control involves (1) a change from less than 50 percent ownership to 50 percent or more ownership of a Licensee or (2) the transfer of controlling interest in the ownership of a Licensee to another party or parties. See Section 1.948(b) of the Commission’s Rules. A Transfer of Control involves a transfer of controlling interest in ownership but generally does not involve the changing of the Licensee’s name. Refer to the applicable FCC rules and decisions for definitions of controlling interest and ownership. Designated Entities, as defined in Section 1.2110(a), must comply with Sections 1.2110 and 1.2111 when seeking to transfer control.

For a Transfer, the Transferor must request approval using FCC Form 603 and generally must receive prior consent (unless the Transfer is Involuntary or a post-consummation notification of a pro forma Transfer) from the FCC before transferring control of the Licensee’s authorization(s). For additional information regarding Transfers that can be filed without receiving prior consent from the FCC, see the sections titled Involuntary Transactions and Post-Consummation Notifications of Pro Forma Transactions.

Both the Transferor and Transferee must sign the form. In addition, if required pursuant to Section 1.919 of the Commission’s Rules, the Transferee must file FCC Form 602, FCC Ownership Disclosure Information for the Wireless Telecommunications Services, unless a current and up-to-date FCC Form 602 is already on file at the FCC.

Involuntary Transactions

An Involuntary Assignment or Transfer involves the death or legal disability of a Licensee, a member of a partnership, or a person directly or indirectly in control of a corporation that is a Licensee. An application for an Involuntary Assignment or Transfer (Item 7 must be ‘Y’, Item 8a must be ‘Involuntary’ and a date must be provided in Item 8b) must be filed within 30 days after the occurrence of such death or legal disability. For additional information, see Section 1.948(g) of the Commission’s Rules. Note: Involuntary applications should also be filed when a Licensee declares bankruptcy.

Post-Consummation Notifications of Pro Forma Transactions

In the case of a non-substantial (pro forma) Assignment or Transfer involving a telecommunications carrier, as defined in Section 153(44) of the Communications Act, prior consent by the FCC is not required provided that the affected license(s) are not subject to unjust enrichment provisions, the Assignment or Transfer does not involve a proxy contest, and the Assignor/Transferor provides notice of the transaction (Item 7 must be ‘Y’, Item 8a must be ‘Voluntary’, Item 9a must be ‘Y’, Item 9b must be ‘Y’ and a date must be provided in Item 9c) within 30 days of completion of the Assignment or Transfer. For additional information, see Section 1.948(c)(1) of the Commission’s Rules.

Notification of Consummation

For an Assignment, the Assignee must sign and submit the FCC Form 603 Main Form and Schedule D within the prescribed time frame outlined below under the section titled 180-Day Period. For a Transfer, the Transferee must sign and submit the FCC Form 603 Main Form and Schedule D within the prescribed time frame outlined below under the section titled 180-Day Period. Note: Notifications of consummation do not have to be filed for post-consummation notifications of a pro forma Assignment or Transfer, or Involuntary Assignment or Transfer.

Note: If parties do not wish to consummate the transaction, the Assignor (for an Assignment) or the Transferor (for a Transfer) may submit an application to withdraw a previously consented to application.

Extension of Time To Consummate

For an Assignment, the Assignor must sign and submit the FCC Form 603 Main Form and Schedule E within the prescribed time frame outlined below under the section titled One Hundred and Eighty-Day Period. For a Transfer, the Transferor must sign and submit the FCC Form 603 Main Form and Schedule E within the prescribed time frame outlined below under the section titled One Hundred and Eighty-Day Period.

180. Day Period

Assignments and Transfers must be consummated and notification provided to the Commission within 180 days of the date of public notice of the FCC consent, and a Notification of Consummation (Main Form and Schedule D) must be filed no later than 30 days after the actual consummation date, unless an Extension of Time To Consummate (Main Form and Schedule E) is filed prior to the expiration of this 180- day period.

Note: If an Assignment or Transfer is not consummated within 180 days of public notice of approval and a timely filed Notification of Consummation is not submitted or a timely filed request for an Extension of Time to Consummate is not submitted, FCC consent to that transaction is no longer valid.

Information Current and Complete

Information filed with the FCC must be kept current and complete. Parties to the application must notify the FCC regarding any substantial and significant changes in the information furnished in the application. See Section 1.65 of the Commission’s Rules.

Applicable Rules and Regulations

Applicants should obtain the relevant parts of the Commission’s Rules, which are located in Part 47 of the Code of Federal Regulations (CFR). Copies of Part 47 CFR may be purchased by contacting the Superintendent of Documents, Government Printing Office, Washington, DC 20402, by calling (202) 512-1800 or by accessing the Government Printing Office’s website at http://www.access.gpo.gov.

Application Fees and Filing Locations

An application fee may be required with this form. To determine the required fee amount, refer to Subpart G of Part 1 of the Commission’s Rules (47 CFR Part 1, Subpart G) and the current Fee Filing Guide. For assistance with fees applicable to the radio services governed by the Commission’s Rules, call (877) 480-3201 (TTY (717) 338-2824). The current Fee Filing Guide can be downloaded from the FCC's website at http://www.fcc.gov/fees, by calling the FCC's Forms Distribution Center at (800) 418-FORM (3676), or from the FCC’s Fax Information System by dialing (202) 418-0177.

Paper applications requiring a fee must be mailed to the Federal Communications Commission, P.O. Box 979097, St. Louis, MO 63197- 9000 or hand delivered to the U.S. Bank, Attn: FCC Government Lockbox #979097, SL-MO-C2-GL, 1005 Convention Plaza, St. Louis, MO 63101.

Non-feeable paper applications should be mailed to Federal Communications Commission, 1270 Fairfield Road, Gettysburg, PA 17325-7245. Hand-deliveries and messenger-deliveries should be delivered to Federal Communications Commission, 1280 Fairfield Road, Gettysburg, PA 17325.

Submission of Paper-Filed Forms

One original paper copy of this application is required to be filed with the Commission. The Main Form and the applicable schedules should be submitted as one package, stapled in the upper left corner. The Main Form should be first, with the schedules attached in alphabetical order.

Exhibits

Each document required to be filed as an exhibit should be current as of the date of filing. Each page of every exhibit must be identified with the number or letter of the exhibit, the number of the page of the exhibit, and the total number of pages of the exhibit. If material is to be incorporated by reference, see the instruction on incorporation by reference.

Note: Some Commission Rules require Applicants to attach one or more exhibits to an application in addition to the information requested in the application form.

Incorporation by Reference

You may incorporate by reference documents, exhibits, or other lengthy showings already on file with the FCC only if the information previously filed is more than one 8 1/2” by 11” page in length, all information therein is current and accurate in all significant respects, and the reference states specifically where the previously filed information can be found (i.e., station call sign and application file number, title of proceeding, docket number and legal citations), including exhibit and page references. Items that call for numbers or that can be answered ‘Y’ or ‘N’ or with other short answers must be answered directly without reference to a previous filing.

Assistance with Completing this Form

For assistance with this form, contact the Federal Communications Commission, 1270 Fairfield Road, Gettysburg, PA 17325-7245, or call (877) 480-3201 (TTY (717) 338-2824).

Technical Assistance for Electronic Filers

For technical assistance with filing electronically, contact the FCC at (877) 480-3201.

Instructions for FCC Form 603 Main Form

General Information

Item 1 Indicate the purpose for which the application is being filed by inserting the appropriate two-letter abbreviation from the following list (only one purpose may be specified).

AA - Assignment of Authorization

TC - Transfer of Control

AM - Amendment: To amend a previously filed, currently pending application. Use Item 2 to provide the File Number of the previously filed application. All appropriate schedules must be completed and attached, and must accurately reflect the effect and purpose of the amendment.

WD - Withdrawal: To withdraw a previously filed, currently pending or consented to application. Use Item 2 to provide the File Number of the pending or consented to application.

NT - Required Notification: To notify the FCC that, within the required time period, an Assignment or Transfer has been consummated.

EX - Request for Extension of Time: To request additional time to consummate an Assignment or Transfer.

Item 2 If the filing is an amendment or withdrawal of a previously filed application, provide the File Number of the original application. This information can be obtained by using ULS Application Search or by contacting the FCC at (877) 480-3201 (TTY 717-338-2824).

Item 3a Enter ‘Y’ if this application is one in a series of related applications involving other wireless licenses. Otherwise, enter ‘N’.

The purpose of this item is to indicate whether the proposed transaction involves other wireless licenses not listed on this filing that are held by the Licensee, affiliates of the Licensee, or third parties (e.g., spectrum swaps or multi-party transactions). For this purpose, "affiliates" is defined in Section 1.2110(a)(4) of the Commission’s Rules, and includes parents, subsidiaries, or commonly-controlled entities. Where a transaction involves the Assignment or Transfer of multiple licenses held by a single Licensee, a single form should be filed whenever possible. Where a transaction involves the Assignment or Transfer of licenses by affiliated Licensees or third-party Licensees, a separate form must be filed for each Licensee. Parties who seek to assign or transfer licenses as part of a larger transaction or plan on filing multiple applications are strongly encouraged to contact the Wireless Telecommunications Bureau in advance of filing this form.

Item 3b If the response to 3a is ‘Y’ and this filing is the lead application, enter ‘Y’. Otherwise, enter ‘N’.

Item 3c If the response to 3b is ‘N’, provide the File Number of the lead application for this transaction. The lead application should contain an exhibit fully describing the proposed transaction. Any additional applications included as part of the proposed transaction must cross-reference this exhibit unless each additional application also includes the exhibit fully describing the proposed transaction.

Item 3d Enter ‘Y’ if the transaction that is the subject of this filing also involves the Assignment or Transfer of non-wireless licenses or authorizations for which Commission approval or notification is required (e.g., Section 214 authorizations, wireline or media authorizations).

Item 4 Enter ‘Y’ if attachments (other than associated schedules) are being filed with this application. Otherwise, enter ‘N’.

Note: Section 310(d) of the Communications Act requires the Commission to determine that the public interest, convenience, and necessity would be served by the proposed Assignment or Transfer. To enable the Commission to make this determination, Applicants may in some instances be required to provide, by means of an attachment, additional information not specifically requested elsewhere on FCC Form 603 to establish the qualifications of the Assignee or Transferee or to otherwise demonstrate that the proposed transaction is in the public interest. The burden is on the Applicants to determine whether such additional information is necessary under Section 310(d) in light of the circumstances of the particular transaction. For example, if: 1) the application involves a non-pro forma Assignment or Transfer of a license in a subscriber-based service, and 2) the proposed Assignee or Transferee, its parent or any affiliate, directly or indirectly owns, controls, or holds an attributable interest in any other entity authorized to provide FCC-regulated subscriber-based services in a geographic area that overlaps the service area of a license that is the subject of the proposed Assignment or Transfer, the Applicants should generally file an attachment with their FCC Form 603 setting forth the factual circumstances and describing how the proposed transaction meets the public interest standard of Section 310(d). Applicants seeking further guidance on this issue are encouraged to contact the Wireless Telecommunications Bureau in advance of filing FCC Form 603.

Fees and Waivers

Item 5a This item notifies the FCC that the Applicant is exempt from FCC application fees. If the response is ‘Y’, an exhibit demonstrating the Applicant’s eligibility for exemption from FCC application fees must be submitted with this filing. For additional information regarding an Applicant’s eligibility to be exempt from FCC application fees, see the current Fee Filing Guide or call (877) 480-3201 (TTY 717-338-2824).

Item 5b If a request for waiver/deferral of the FCC application fees is being filed with the FCC in conjunction with this filing and the application fees are not being submitted, enter ‘Y’. Otherwise, enter ‘N’. If ‘Y’, attach an exhibit with the date-stamped copy of the waiver/deferral request filed with the Commission’s Office of the Managing Director/Office of General Counsel. Otherwise, enter ‘N’.

Item 6a If the filing includes a request for waiver of the Commission’s Rules (other than FCC application fees), enter ‘Y’ and attach an exhibit specifying the rule section(s) for which a waiver is being requested and demonstrating a justification for the requested waiver. See Section 1.925 of the Commission’s Rules. Otherwise, enter ‘N’.

Item 6b If the response to 6a is ‘Y’, provide the number of rule sections involved (do not enter the actual rule section(s)).

Additional Transaction Information

Item 7a Enter ‘Y’ if the Assignment or Transfer has already occurred. Otherwise, enter ‘N’.

If the response to Item 7a is ‘Y’, the response to Item 8a is Voluntary, and the response to Item 9a or Item 9b is ‘N’, attach an exhibit explaining the circumstances.

Item 7b If the response to Item 7a is ‘Y’, provide the date the event occurred.

Item 8 Indicate whether the Assignment or Transfer is Voluntary or Involuntary by checking the appropriate selection. For additional information regarding involuntary transactions, see Section 1.948(g) of the Commission’s Rules.

Item 9a Enter ‘Y’ in this item if the application is a pro forma Assignment or Transfer. Otherwise, enter ‘N’. If the response to this item is ‘Y’, a response to Item 9b is required.

A pro forma assignment of authorization is one for which the actual controlling party does not change. For example, if an authorization is assigned by one wholly-owned subsidiary of a parent corporation to another wholly-owned subsidiary of the same corporation, this would be a pro forma Assignment of Authorization.

A pro forma transfer of control is one for which the actual controlling party does not change. For example, a corporate restructuring that changes the chain of ownership to the controlling corporation may give rise to a pro forma Transfer of Control of a Licensee.

Item 9b Enter ‘Y’ if this is a post-consummation notification of a pro forma Assignment or Transfer that is subject to the FCC's forbearance procedures pursuant to Section 1.948(c)(1) of the Commission’s Rules. Otherwise enter ‘N’.

Item 10a For Assignments of Authorization only (purpose AA in Item 1): Enter ‘Y’ if this application is being filed to partition or disaggregate a geographic-area license(s). Otherwise, enter ‘N’. If the response to this item is ‘Y’, Schedule B and, if applicable, Schedule C must be completed. For additional information, see Section 1.948(f) of the Commission’s Rules.

Item 10b For Assignments of Authorization only (purpose AA in Item 1): Enter ‘Y’ if this application is being filed to partially assign a site- based license(s). Otherwise, enter ‘N’. For additional information, see Section 1.948(e) of the Commission’s Rules.

Item 11 This item indicates how the Assignment or Transfer is to be accomplished. If the facilities and other assets are to be sold, answer this item ‘S’. If stock or other ownership interests in the Licensee or entity controlling the Licensee are to be assigned or transferred to another entity, answer this item ‘T’. If the Assignment or Transfer is to be accomplished pursuant to court order (e.g., to an estate, debtor- in-possession, or trustee), answer this item ‘C’. If the Assignment or Transfer is to be accomplished by a court-supervised reorganization, or liquidation, answer this item ‘R’. If the response is ‘O’, explain in an exhibit how the Assignment or Transfer is to be accomplished.

Designated Entity Information

Item 12a Enter ‘Y’ if the Assignment or Transfer involves any licenses that were awarded with bidding credits within the last five years. Otherwise, enter ‘N’.

The initial grant date is the date that the license was originally granted by the Commission after an auction, even if the license was acquired in the secondary market. The initial grant date is not the date on which the Commission granted an assignment or transfer of control of the license.

If the response to this item is ‘Y’, the license may be subject to the FCC’s unjust enrichment rules. See Sections 1.2111 of the Commission’s Rules. If the response to this item is ‘Y’, Schedule A must be completed.

Item 12b Enter ‘Y’ if the Assignment or Transfer involves a license that was originally awarded pursuant to closed bidding within the last five years. Otherwise, enter ‘N’.

If the response to this item is ‘Y’, the license may be subject to assignment or transfer restrictions. See Sections 24.709 and 24.839 of the Commission’s Rules. If the response to this item is ‘Y’, Schedule A must be completed.

Competition Related Information

Item 13 Enter ‘Y’ if this application for Assignment or Transfer involves a license that may be used for interconnected mobile voice and/or data services that would create a geographic overlap with another license, that also could be used to provide interconnected mobile voice and/or data services, in which the Assignee/Transferee already holds attributable interests, as defined in Section 20.22(b) of the Commission’s Rules, either as a licensee or spectrum lessee/sublessee. Otherwise, enter ‘N’.

If ‘Y’, specify in an exhibit all geographic areas/markets (e.g., BTA, CMA, county, etc.) where there are spectrum overlaps and the total amount of spectrum that the Assignee/Transferee will hold and/or lease in each geographic area/market.

Item 14 Enter ‘Y’ if the Assignment or Transfer will result in the loss of one or more service provider(s)/competitor(s) in any of the overlap geographic areas/markets. Otherwise, enter ‘N’.

Broadband Radio Service and Educational Broadband Service Information

These items enable the FCC to determine whether the Assignee/Transferee complies with Section 27.1202 of the Commission’s Rules. Item 15a If the proposed facilities will be used to provide multichannel video programming, enter ‘Y’. Otherwise, enter ‘N’.

Item 15b If response to 15a is ‘Y’, and the Applicants will operate, control, or have an attributable interest in a cable television system whose franchise area is located within the geographic service area of the proposed facilities, enter ‘Y’. Otherwise, enter ‘N’.

If ‘Y’, provide an exhibit explaining how the Assignee/Transferee complies with Section 27.1202 of the Commission’s Rules or justifying a waiver of that rule. If a waiver of the Commission’s Rule(s) is being requested, 6a must be answered ‘Y’.

This item enables the FCC to determine whether the Assignee/Transferee complies with Section 27.1202 of the Commission’s Rules.

Item 16 Enter ‘Y’ if the Assignee/Transferee complies with the programming requirements contained in Section 27.1203 of the Commission’s Rules. Otherwise, enter ‘N’.

If ‘N’, provide an exhibit explaining how the Assignee/Transferee complies with Section 27.1203 of the Commission’s Rules or justifying a waiver of that rule. If a waiver of the Commission’s Rule(s) is being requested, 6a must be answered ‘Y’.

600 MHz Band Information

Item 17 Enter ‘Y’ if the Assignment or Transfer involves any licenses in the 600 MHz Band initially granted in the last six years that would, if assigned/transferred, create a geographic overlap with another licenses(s) in which the Assignee/Transferee already holds attributable interests, as defined in Section 20.22(b) of the Commission’s Rules, either as a Licensee or Assignee/Transferee, and that would result in the Assignee/Transferee holding an attributable interest, as defined in Section 20.22(b) of the Commission’s Rules, in one-third or more of the total suitable and available below-1-GHz spectrum as calculated on a county-by-county population-weighted basis in the relevant license area, utilizing 2010 U.S. Census data. Otherwise, enter ‘N’.

The initial grant date is the date that the license was originally granted by the Commission after an auction, even if the license was acquired in the secondary market. The initial grant date is not the date on which the Commission granted an assignment or transfer of control of the license.

If the response to this item is ‘Y’, this application for Assignment or Transfer application must be part of an exchange of 600 MHz band spectrum in the same market(s) or must be a pro forma Assignment or Transfer. If the response is ‘Y’, provide an exhibit detailing the proposed exchange of 600 MHz band spectrum in the same market(s), including a list of all file numbers for applications associated with the proposed spectrum exchange, or describing the pro forma nature of the transaction, as appropriate to the Assignment or Transfer.

Item 18 Enter ‘Y’ if the Assignment or Transfer involves any licenses that were initially granted as reserved spectrum licenses in the 600 MHz Band in the last six years. Otherwise, enter ‘N’.

The initial grant date is the date that the license was originally granted by the Commission after an auction, even if the license was acquired in the secondary market. The initial grant date is not the date on which the Commission granted an assignment or transfer of control of the license.

If the response to this item is ‘Y’, the proposed Assignee/Transferee must have been qualified to bid on that reserved spectrum license(s) under Section 20.22(c)(1) of the Commission’s Rules as of the FCC Form 175 filing deadline for Auction 1002 (February 10, 2016), the forward auction of the Broadcast Incentive Auction, and must provide an exhibit demonstrating how the proposed Assignee/Transferee would have qualified to bid on that reserved spectrum license(s) in Auction 1002 as of the FCC Form 175 filing deadline for Auction 1002 (February 10, 2016).

Licensee/Assignor Information

Items 19 through 31 identify the person or entity that is applying to assign the authorizations (Assignment of Authorization) or the Licensee in a Transfer of Control.

Item 19 This item indicates the legal entity type of the Assignor (Assignment) or Licensee (Transfer). Select Individual, Unincorporated Association, Trust, Government Entity, Corporation, Limited Liability Company, General Partnership, Limited Partnership, Limited Liability Partnership, or Other. When selecting ‘Other’, provide a description of the legal entity.

Item 20 Enter the ten-digit FRN assigned by the Commission Registration System (CORES). The FRN is a unique entity identifier for everyone doing business with the Commission. The FRN can be obtained electronically through the FCC webpage at http://wireless.fcc.gov/uls or by manually submitting FCC Form 160. FCC Form 160 is available for downloading from http://www.fcc.gov/formpage.html. Failure to provide the FRN will prevent the Commission from processing the application.

Items 21-29 Complete either Item 21 or Item 22, depending on whether the Assignor/Licensee is an individual or company, respectively. If completing Item 22, enter the individual to contact in Item 23. You may enter a post office box number in Item 24 or a street address in Item 25, or enter information for both items. Enter the city, state, and zip code in Items 26, 27, and 28. Refer to FCC Form 603 Main Form Instructions, Appendix I, for a list of valid state, jurisdiction, and area abbreviations. Enter a telephone number, including area code, in Item 29.

Note: The full legal name is required for Items 21 and 22.

Items 30 and 31 Enter the Assignor/Licensee fax number and e-mail address, if desired and available.

Failure to respond to FCC correspondence sent to the address of record may result in dismissal of an application, liability for forfeiture, or revocation of an authorization.

Demographics of Assignor/Licensee (Optional)

Item 32 The information is optional and is requested for informational purposes only. Responses to this item will in no way affect processing of applications.

Assignor/Licensee Contact Representative

Items 33-43 These items identify the contact representative for the Assignor/Licensee, if different from the Assignor/Licensee. This is usually the headquarters office of a large company, the law firm or other representative of the Assignor/Licensee, or the person or company that prepared or submitted the application on behalf of the Assignor/Licensee. If there is a question about the application, an FCC representative will communicate with the contact representative.

If the contact representative is the same as the Assignor/Licensee, check the box and do not complete the remaining items in this section. If the contact representative is not the same as the Assignor/Licensee, then provide the information and complete this section as follows:

• Either the Individual Name or the Company Name is required.

• If Individual Name is completed, then Company Name and Attention to are not required.

• If Company Name is completed, then either an Individual Name or the Attention to is required.

• Either a PO Box or a Street Address is required. Both may be provided.

• City, State and Zip Code are required.

• Telephone Number is required (including area code).

• FAX Number and E-Mail Address are optional.

Transferor Information (for transfers of control only)

Items 44 through 56 identify the person or entity that is applying for consent to transfer control of the Licensee.

Item 44 This item indicates the legal entity type of the Transferor. Select Individual, Unincorporated Association, Trust, Government Entity, Corporation, Limited Liability Company, General Partnership, Limited Partnership, Limited Liability Partnership, or Other. When selecting ‘Other’, provide a description of the legal entity.

Item 45 Enter the Transferor’s ten-digit FRN assigned by the Commission Registration System (CORES). The FRN is a unique entity identifier for everyone doing business with the Commission. The FRN can be obtained electronically through the FCC website at http://www.fcc.gov or by manually submitting FCC Form 160. FCC Form 160 is available for downloading from http://www.fcc.gov/formpage.html, Failure to provide the FRN will prevent the Commission from processing the application.

Items 46-54 Complete either Item 46 or Item 47, depending on whether the Transferor is an individual or company, respectively. If completing Item 47, enter the individual to contact in Item 48. You may enter a post office box number in Item 49 or a street address in Item 50, or enter information for both items. Enter the city, state, and zip code in Items 51, 52, and 53. Refer to FCC Form 603 Main Form Instructions, Appendix I, for a list of valid state, jurisdiction, and area abbreviations. Enter a telephone number, including area code, in Item 54.

Note: The full legal name is required for Items 46 and 47.

Items 55 and 56 Enter the Transferor fax number and e-mail address, if desired and available.

Failure to respond to FCC correspondence sent to the address of record may result in dismissal of an application, liability for forfeiture, or revocation of an authorization.

Demographics of Transferor (Optional)

Item 57 The information is optional and is requested for informational purposes only. Responses to this item will in no way affect processing of applications.

Transferor Contact Representative

Items 58-68 These items identify the contact representative for the Transferor, if different from the Transferor. This is usually the headquarters office of a large company, the law firm or other representative of the Transferor, or the person or company that prepared or submitted the application on behalf of the Transferor. If there is a question about the application, an FCC representative will communicate with the contact representative.

If the contact representative is the same as the Transferor, check the box and do not complete the remaining items in this section. If the contact representative is not the same as the Transferor, then provide the information and complete this section as follows:

• Either the Individual Name or the Company Name is required.

• If Individual Name is completed, then Company Name and Attention To are not required.

• If Company Name is completed, then either an Individual Name or the Attention To is required.

• Either a PO Box or a Street Address is required. Both may be provided.

• City, State and Zip Code are required.

• Telephone Number is required (including area code).

• FAX Number and E-Mail Address are optional.

Assignee/Transferee Information

Items 69 through 83 identify the person or entity that is applying to become or control the Licensee of the authorizations listed in this application. For an Assignment of Authorization, the information provided in these items will become the Licensee’s name, address, and telephone number of record, and the authorizations will be sent to this address. The Assignee is the party that will become the new Licensee if the application is granted. In an application for consent to transfer control of the License, the Transferee is the party that will have a controlling interest in the Licensee.

Item 69 This item indicates the legal entity type of the Assignee or Transferee. Select Individual, Unincorporated Association, Trust, Government Entity, Corporation, Limited Liability Company, General Partnership, Limited Partnership, Limited Liability Partnership, or Other. When selecting ‘Other’, provide a description of the legal entity.

Item 70 Enter the Assignee/Transferee’s ten-digit FRN assigned by the Commission Registration System (CORES). The FRN is a unique entity identifier for everyone doing business with the Commission. The FRN can be obtained electronically through the FCC website at http://www.fcc.gov or by manually submitting FCC Form 160. FCC Form 160 is available for downloading from http://www.fcc.gov/formpage.html, Failure to provide the FRN will prevent the Commission from processing the application.

Items 71-72 Complete either Item 71 or Item 72, depending on whether the Assignee/Transferee is an individual or company, respectively.

Note: The full legal name is required for Items 71 and 72.

Item 73 If completing Item 72, enter the contact person for the Assignee/Transferee.

Item 74 Enter the real party in interest’s ten-digit FRN assigned by the Commission Registration System (CORES). The FRN is a unique entity identifier for everyone doing business with the Commission. The FRN can be obtained electronically through the FCC website at http://www.fcc.gov or by manually submitting FCC Form 160. FCC Form 160 is available for downloading from. http://www.fcc.gov/formpage.html, if the Assignee or Transferee is also the real party in interest, enter the Assignee’s or Transferee’s FRN in this item. Failure to provide the FRN will prevent the Commission from processing the application.

Item 75 The Assignee or Transferee must identify the real party (parties) in interest. If the Assignee or Transferee is also the real party in interest, enter the Assignee’s or Transferee’s name in this item. If a party other than the Assignee or Transferee is the real party in interest (e.g., a parent or other controlling entity), enter that party's name in this item. If there is more than one real party in interest, attach an exhibit detailing all parties in interest.

The real party in interest is defined as a person who “has an ownership interest, or will be in a position to actually or potentially control the operation of the station.” Astroline Communications Co. Ltd. v. FCC, 857 F.2d 1556, 1564 (D.C. Cir. 1988); see also In Re Applications of Georgia Public Telecommunications Commission, et al., MM Docket No. 89-337, 7 FCC Rcd 7996 (1992); In Re Applications of Madalina Broadcasting, et al., MM Docket No. 91-100, 8 FCC Rcd 6344 (1993).

Items 76-81 Enter the address and telephone number of the person to whom the FCC should send correspondence. You may enter a post office box number in Item 76 or a street address in Item 77, or enter information for both items. Enter the city, state, and zip code in Items 76, 77, and 78, respectively. Refer to FCC Form 603 Main Form Instructions, Appendix I, for a list of valid state, jurisdiction, and area abbreviations. Enter a telephone number, including area code, in Item 81.

Items 82 and 83 Enter the Assignee/Transferee fax number and e-mail address, if desired and available.

Failure to respond to FCC correspondence sent to the address of record may result in dismissal of an application, liability for forfeiture, or revocation of an authorization.

Demographics of Assignee/Transferee (Optional)

Item 84 The information is optional and is requested for informational purposes only. Responses to this item will in no way affect processing of applications.

Assignee/Transferee Contact Representative

Items 85-95 These items identify the contact representative for the Assignee/Transferee, if different from the Assignee/Transferee. This is usually the headquarters office of a large company, the law firm or other representative of the Assignee/Transferee, or the person or company that prepared or submitted the application on behalf of the Assignee/Transferee. If there is a question about the application, an FCC representative will communicate with the contact representative.

If the contact representative is the same as the Assignee/Transferee, check the box and do not complete the remaining items in this section. If the contact representative is not the same as the Assignee/Transferee, then provide the information and complete this section as follows:

• Either the Individual Name or the Company Name is required.

• If Individual Name is completed, then Company Name and Attention To are not required.

• If Company Name is completed, then either an Individual Name or the Attention To is required.

• Either a PO Box or a Street Address is required. Both may be provided.

• City, State and Zip Code are required.

• Telephone Number is required (including area code).

• FAX Number and E-Mail Address are optional.

Ownership Disclosure Information

Item 96a Enter ‘Y’ if the Assignee/Transferee is required to file FCC Form 602, Ownership Disclosure Information for the Wireless Telecommunications Services.

Item 96b If 96a is ‘Y’, provide the File Number of the FCC Form 602 submitted in conjunction with this application or already on file with the FCC.

Alien Ownership Questions

These items enable the FCC to determine whether an Applicant is eligible under Section 310(a) and (b) of the Communications Act of 1934, as amended, to hold or have ownership interests in a License. The Assignee/Post-Transfer Licensee is required to answer these questions only if it is filing FCC Form 603 for one of the following purposes indicated in Item 1: Assignment of Authorization or Transfer of Control. An Assignee/Post-Transfer Licensee using FCC Form 603 for any other purpose is not required to answer these questions. Any applicant that answers ‘Y’ to Items 98 – 101a must provide an attachment explaining the circumstances. The FCC will otherwise dismiss the Application without further consideration.

The Commission’s foreign ownership rules for common carrier, aeronautical en route and aeronautical fixed radio station licensees are codified in Sections 1.990 through 1.994 of the Commission’s Rules, 47 C.F.R. §§ 1.990-1.994. See also Review of Foreign Ownership Policies for Common Carrier and Aeronautical Radio Licensees under Section 310(b)(4) of the Communications Act of 1934, as amended, IB Docket No. 11-133, Second Report and Order, FCC 13-50, 28 FCC Rcd 5741 (2013) (“Foreign Ownership Second Report and Order”). The foreign ownership rules will be renumbered and codified in Sections 1.5000 through 1.5004 of the Commission's rules, 47 CFR s 1.5000-1.5004, subject to OMB approval, in accordance with the Commission's decision in Review of Foreign Ownership Policies for Broadcast, Common Carrier and Aeronautical Radio Licensees under Section 310(b)(4) of the Communications Act of 1934, as amended, GN Docket No. 15-236, FCC 16-128, 31 FCC Rcd 11272 (2016).

Item 97 The Assignee/Post-Transfer Licensee filing FCC Form 603 for one of the purposes indicated above must answer Item 97. The FCC cannot grant an authorization to a foreign government or the representative of a foreign government. Therefore, if the true and correct answer to Item 95 is ‘Y’, Assignee/Post-Transfer Licensee is not eligible to hold a license and the FCC will dismiss the application without further consideration.

Items 98-99 The FCC cannot grant an authorization to provide common carrier or aeronautical en route service to any Applicant for which the true and correct answer to either of Items 98 or 99 is ‘Y’. Any Applicant that answers ‘Y’ to either of Items 98 or 99 must provide an attachment explaining why the License(s) that is the subject of the application is exempt from the prohibitions contained in § 310(b)(1)-(2) of the Communications Act, 47 U.S.C. § 310(b)(1)-(2). The FCC will otherwise dismiss the application without further consideration.

Item 100 Enter ‘Y’ if the Assignee/Post-Transfer Licensee is 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. Otherwise, enter ‘N’. If the answer is ‘Y’, and if any license(s) to be transferred or assigned would allow for the provision of a common carrier service, it is necessary for the Assignee/Post-Transfer Licensee to have or obtain Commission approval. See 47 C.F.R. § 1.990(a)(2). If the answer is ‘Y’, and if any license(s) to be transferred or assigned would allow for the provision of aeronautical en route service, the Applicant must provide an attachment explaining why the requested license is exempt from the prohibitions contained in Section 310(b)(3) of the Communications Act, 47 U.S.C. § 310(b)(3). The FCC will otherwise dismiss the application without further consideration.

While Section 310(b)(3) of the Communications Act prohibits foreign individuals, governments, and corporations from owning more than 20 percent of the capital stock of a broadcast, common carrier, aeronautical en route, and aeronautical fixed radio station licensee, the Commission has determined that it will not apply the 20 percent limit to common carrier licensees in which the foreign investment is held in the licensee through U.S.-organized entities that do not control the licensee, to the extent the Commission determines such foreign ownership is consistent with the public interest. In making a public interest determination, the Commission applies the same policies and procedures that it applies in reviewing foreign ownership that is subject to Section 310(b)(4) of the Communications Act. The Commission

adopted this Section 310(b)(3) “forbearance” approach in the Foreign Ownership First Report and Order, IB Docket No. 11-133, FCC 12-93, 27 FCC Rcd 9832 (2012). The Commission codified the forbearance approach in the Foreign Ownership Second Report and Order, IB Docket No. 11-133, FCC 13-50 at ¶¶ 30-37.

The Commission’s Section 310(b)(3) forbearance approach applies only to foreign equity and voting interests that are held, or would be held, in the common carrier Assignee/Post-Transfer Licensee through one or more intervening U.S.-organized entities that do not control the Assignee/Post-Transfer Licensee. Foreign equity and/or voting interests that are held, or would be held, directly in the Assignee/Post- Transfer Licensee, or indirectly other than through an intervening U.S.-organized entity, are not subject to the Commission’s Section 310(b)(3) forbearance approach and shall not be permitted to exceed 20 percent equity or voting interests.

Accordingly, if any license to be transferred or assigned would allow for the provision of a common carrier service, an Assignee/Post- Transfer Licensee that answers ‘Y’ to Item 100 must provide an attachment consisting of one of the showings specified in (i), (ii), or (iii) below. The FCC will otherwise dismiss the application without further consideration.

1. A demonstration that the subject License(s) is exempt from the provisions of Section 310(b)(3);

2. A statement that the Assignee/Post-Transfer Licensee has received prior Commission approval of its foreign ownership pursuant to the Commission’s Section 310(b)(3) forbearance approach, citation(s) to the relevant declaratory ruling(s) received by the Assignee/Post- Transfer Licensee (i.e., DA or FCC Number, FCC Record citation if available, and release date), and a statement specifying that the Assignee/Post-Transfer Licensee is in compliance with the terms and conditions of its ruling and with the Commission’s Rules; or

3. A copy of a petition for declaratory ruling filed pursuant to Section 1.990(a)(2) of the Commission’s Rules, 47 C.F.R. § 1.990(a)(2), requesting Commission approval of the Assignee/Post-Transfer Licensee’s foreign ownership, held through one or more intervening U.S.- organized entities that hold non-controlling equity and/or voting interests in the Assignee/Post-Transfer Licensee, along with any foreign interests held in the Assignee/Post-Transfer Licensee directly (which shall not exceed 20 percent of its equity interests and/or 20 percent of its voting interests). The petition may be filed electronically on the Internet through the International Bureau Filing System (IBFS) and shall otherwise comport with the requirements of Sections 1.990 through 1.994 of the Commission’s Rules, 47 C.F.R. §§ 1.990-1.994.

With respect to the showing specified in (ii) above, an Assignee/Post-Transfer Licensee that is relying on a foreign ownership ruling(s) issued to an “affiliate” pursuant to the Commission’s Section 310(b)(3) forbearance approach and Section 1.990(a)(2) of the Rules, shall include in its showing a certification signed by the affiliate, a U.S.-organized successor-in-interest formed as part of a pro forma reorganization, or a controlling parent company, stating that the affiliate or successor-in-interest is in compliance with the terms and conditions of the foreign ownership ruling(s) and the Commission’s Rules. See Section 1.994(b) of the Rules, 47 C.F.R. § 1.994(b). See also Section 1.990(d)(2) (defining the term “affiliate” for purposes of Sections 1.990-1.994 of the Rules).

Item 101a Enter ‘Y’ if the Assignee/Post-Transfer Licensee is directly or indirectly controlled by any other U.S.-organized entity of which more than one-fourth 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. Otherwise, enter ‘N’. If the answer is ‘Y’, and if any license(s) to be transferred or assigned would allow for the provision of a common carrier or aeronautical en route service, it is necessary for the Assignee/Post-Transfer Licensee to have or obtain Commission approval of the foreign ownership of its direct and/or indirect controlling U.S.-organized parent company(ies) pursuant to Section 310(b)(4) of the Communications Act , 47 U.S.C. § 310(b)(4). See 47 C.F.R. § 1.990(a)(1); Foreign Ownership Second Report and Order, IB Docket No. 11-133, FCC13-50 ¶¶ 30-37.

Accordingly, any Assignee/Post-Transfer Licensee that answers ‘Y’ to Item 101a must provide an attachment consisting of one of the showings specified in (i), (ii), or (iii) below. The FCC will otherwise dismiss the application without further consideration.

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1. A demonstration that the subject License(s) is exempt from the provisions of Section 310(b)(4);

2. A statement that the Assignee/Post-Transfer Licensee has received prior Commission approval of the foreign ownership of its direct and/or indirect controlling U.S. parent company(ies) pursuant to Section 310(b)(4), citation(s) to the relevant declaratory ruling(s) received by the Assignee/Post-Transfer Licensee (i.e., DA or FCC Number, FCC Record citation if available, and release date), and a statement specifying that the Assignee/Post-Transfer Licensee is in compliance with the terms and conditions of its ruling and with the Commission’s Rules; or

3. A copy of a petition for declaratory ruling filed pursuant to Section 1.990(a)(1) of the Commission’s Rules, 47 C.F.R. § 1.990(a)(1), requesting Commission approval of the foreign ownership of its direct and/or indirect controlling U.S.-organized parent company(ies). The petition may be filed electronically on the Internet through the International Bureau Filing System (IBFS) and shall otherwise comport with the requirements of Sections 1.990 through 1.994 of the Commission’s Rules, 47 C.F.R. §§ 1.990-1.994.

With respect to the showing specified in (ii) above, an Assignee/Post-Transfer Licensee that is relying on a foreign ownership ruling(s) issued to an “affiliate” pursuant to Section 310(b)(4) of the Act and Section 1.990(a)(1) of the Rules shall include in its showing a certification signed by the affiliate, a U.S.-organized successor-in-interest formed as part of a pro forma reorganization, or a controlling parent company, stating that the affiliate or successor-in-interest is in compliance with the terms and conditions of the foreign ownership ruling(s) and the Commission’s Rules. See Section 1.994(b) of the Rules, 47 C.F.R. § 1.994(b). See also Section 1.990(d)(2) (defining the term “affiliate” for purposes of Sections 1.990-1.994 of the Rules).

Item 101b An Assignee/Post-Transfer Licensee that has answered ‘Y’ to Item 100 and/or Item 101a is required to respond to Item 101b. Item 101b has two purposes. First, Item 101b enables the FCC to determine whether the Assignee/Post-Transfer Licensee has attached to its application the appropriate foreign ownership showing required by the Commission’s Foreign Ownership Second Report and Order, IB Docket No. 11-133, FCC 13-50 and the foreign ownership rules adopted in that Order, 47 C.F.R. §§ 1.990-1.994. See Main Form Instructions for Item 100 and Item 101a.

Second, Item 101b enables the FCC to determine whether the application may be eligible for the “immediate approval” procedures in Section 1.948(j)(2) of the Rules, 47 C.F.R. § 1.948(j)(2).

The application may be eligible for the Commission’s immediate approval procedures if the Assignee/Post-Transfer Licensee is able to select the first or second option in Item 101b. Specifically, the application may be eligible for the Commission’s immediate approval procedures where the Assignee/Post-Transfer Licensee is able to certify that: (1) it is exempt from the provisions of Section 310(b); or (2) it has received a declaratory ruling(s) approving its foreign ownership, and the application involves only the acquisition of additional spectrum for the provision of a wireless service in a geographic coverage area for which the Assignee/Post-Transfer Licensee has been previously authorized. See Foreign Ownership Second Report and Order, IB Docket No. 11-133, FCC13-50 ¶¶ 96, 110.

Basic Qualification Questions

Items 102-104 These items enable the FCC to determine whether an Assignee/Transferee is eligible under Sections 310(d) and 308(b) of the Communications Act of 1934, as amended, to hold or have ownership interest in a station license. The Assignee/Transferee is required to answer these questions only if it is filing FCC Form 603 for one of the following purposes indicated in Item 1: Assignment of Authorization or Transfer of Control. An Assignee/Transferee using FCC Form 603 for any other purpose is not required to answer these questions. If the answer to any one or more of Items 102-104 is ‘Y’, attach as an exhibit a statement explaining the circumstances and a statement giving the reasons why the Assignee/Transferee believes that grant of the application would be in the public interest notwithstanding the actual or alleged misconduct. If the Assignee or Transferee responds ‘Y’ to any question and has previously provided a statement and explanation regarding the circumstances as an attachment to a prior application filed in ULS, and the facts and circumstances are unchanged, the Applicants may refer to the previous application by identifying the application file number and indicating the disposition of the prior application.

Assignor/Transferor Certification Statements

By signing this form, the Assignor/Transferor certifies that the statements listed in this section are true, complete, correct, and made in good faith.

Items 105-107 These items must be completed. To be acceptable for filing, applications and amendments must be signed in accordance with Part 1 of the FCC rules. The signor must be a person authorized to sign the application. Paper originals of applications must bear an original signature. On paper originals, neither rubber-stamped nor photocopied signatures are acceptable. For filers filing electronically via ULS, the electronic signature shall consist of the name of the person authorized to sign typed on the application as a signature.

Assignee/Transferee Certification Statements

By signing this form, the Assignee/Transferee certifies that the statements listed in this section are true, complete, correct, and made in good faith. General Certification (8) is required for applications with licenses for spectrum that is required by Sections 6103, 6401-6403 of the Middle Class Tax Relief and Job Creation Act of 2012, codified at 47 U.S.C. §§ 309, 1413, 1451-1452, to be assigned by a system of competitive bidding under 47 U.S.C. § 309(j) (e.g., radio service AH (AWS-H Block at 1915-1920 MHz and 1995-2000 MHz), radio service AT (AWS-3, 1695-1710 MHz, 1755-1780 MHz and 2155-2180 MHz), and radio service WT (600 MHz band). For purposes of this certification, the term “reasons of national security” means matters relating to the national defense and foreign relations of the United States.

Items 108-110 These items must be completed. To be acceptable for filing, applications and amendments must be signed in accordance with Part 1 of the FCC rules. The signor must be a person authorized to sign the application. Paper originals of applications must bear an original signature. On paper originals, neither rubber-stamped nor photocopied signatures are acceptable. For filers filing electronically via ULS, the electronic signature shall consist of the name of the person authorized to sign typed on the application as a signature.

Authorizations To Be Assigned or Transferred

If this is an application for full Assignment or a Transfer of Control, use this section to identify the authorizations to be assigned (complete only Items 111 (Call Sign), 112 (Radio Service), and 118 (Constructed)). Complete at least one entry in this section and use a separate entry for each authorization. If necessary, attach additional copies of this page to list more authorizations.

If this is an application for a partial Assignment in a site-specific service, use this section to identify the authorizations to be assigned (complete Items 111-118, as appropriate). Complete at least one entry in this section and use a separate entry for each authorization. If necessary, attach additional copies of this page to list more authorizations.

Item 111 In this item list the call signs of the authorizations to be assigned or transferred. Call signs are located on FCC Authorizations.

Note: Assigning call signs without specifying which specific locations, paths (Microwave Services only), or frequencies are to be assigned for that call sign will result in all locations, paths, and frequencies for that call sign being assigned. Use Item

113 to specify which (if any) specific locations are to be assigned. Use Item 114 to specify which (if any) specific paths (Microwave Services only) are to be assigned. Use Items 115, 116, and 117 to specify which (if any) specific frequencies are to be assigned.

Item 112 In this item list the Radio Service of the call sign to be assigned.

Item 113 In this item list the location numbers to be assigned. Location numbers are located on FCC Authorizations.

Note: Assigning locations without specifying which specific frequencies are to be assigned for that location will result in all frequencies at that location being assigned. Use Items 115, 116, and 117 to specify which (if any) specific frequencies are to be assigned.

Item 114 In this item list the path numbers to be assigned (Microwave Services only). Path numbers are located on FCC Authorizations.

Note: Assigning paths without specifying which specific frequencies are to be assigned for that path will result in all frequencies on that path being assigned. Use Items 115, 116, and 117 to specify which (if any) specific frequencies are to be assigned.

Item 115 In this item list the frequency number to be assigned. Frequency numbers are located on FCC authorizations.

Items 116 and 117 In these items list the frequencies, in Megahertz (MHz), to be assigned. Enter the center frequency, or the lower frequency of a frequency band, in Item 116. If applicable, enter the upper frequency of a frequency band in Item 117. Frequencies are located on FCC authorizations or can be located by accessing the Universal Licensing System’s license search.

Item 118 Enter ‘Y’ if the facilities have been constructed. Otherwise, enter ‘N’.

Instructions for Schedule for Licensees that Received Bidding Credits or Involving Licenses Won in Closed Bidding

FCC Form 603, Schedule A

FCC Form 603 Schedule A is a supplementary schedule. Complete this schedule when an Assignment or Transfer involves a license(s) that was originally awarded through the competitive bidding process and the original Licensee or current Licensee obtained bidding credits, or was otherwise subject to special provisions applicable to entrepreneurs, and closed bidding licenses. This schedule establishes whether the Assignee (Assignment of Authorization) or the post-transaction Licensee (Transfer of Control) is eligible for the same special provisions as the current Licensee, or whether unjust enrichment provisions or other restrictions apply.

Bidding Credits

Item 1 Enter ‘Y’ if the full amount of bidding credits awarded with regard to each subject license has been paid as part of unjust enrichment payment(s) in previous transaction(s). Otherwise, enter ‘N’. If ‘Y’ is entered, Item 2 is not required to be completed.

Item 2a If the Assignee/Transferee qualifies for the same designated entity benefit as the current Licensee, it should so indicate by checking the first box. If the Assignee/Transferee qualifies for a designated entity benefit, but does not qualify for as high of a percentage of bidding credit as received by the Licensee, the Assignee/Transferee should respond by checking the second box. The Assignee/Transferee may request the same designated entity status as the current Licensee or a different designated entity status from the current Licensee, either as a small business as defined in Section 1.2110(f)(2) or as a rural service provider as defined in Section 1.2110(f)(4), but not both. If the Assignee/Transferee does not qualify for any designated entity status, the Assignee/Transferee should respond by checking the third box. If the Assignee/Transferee checks either the second box or the third box, an unjust enrichment payment WILL be required. See Secondary Markets First Report and Order, 18 FCC Rcd at 20666-67, para. 145.

Item 2b If the Assignee/Transferee requests designated entity status, it must select the appropriate designated entity status. If selecting the small business bidding credit, provide the bidding credit percentage (15%, 25% or 35%).

If the Assignee/Transferee selects the small business bidding credit, complete Items 5-33. If the Applicant selects rural service provider bidding credit, complete item 34.

For either bidding credit, attach an exhibit that includes the information required by the Commission’s Rules, including any agreements, whether oral or written, that could affect the Applicant’s eligibility for designated entity benefits, including but not limited to partnership agreements, shareholder agreements, management agreements, spectrum leasing agreements, spectrum use agreements, spectrum resale (including wholesale) arrangements, and all agreements or arrangements establishing de facto and/or de jure control of the Applicant or of the subject licenses.

Closed Bidding Licenses

Item 3 Enter ‘Y’ if construction notifications have been submitted for each of the subject licenses. Otherwise, enter ‘N’. If ‘Y’ is entered, Item 4 is not required to be completed.

Item 4 Check the appropriate selection: a) the Applicant qualifies for closed bidding, or b) the Applicant does not qualify for closed bidding.

If selection ‘a’ is checked, attach an exhibit that includes revenue and asset information pursuant to the Commission’s Rules.

Revenue and Asset Information for the Applicants

Item 5 If filing an Amendment application, check the block if modifying the Revenue and Asset Information from what was provided on the original filing. When modifying the data that was provided on the original filing, only enter the items that have changed. This item is not required to be completed on the original filing.

Gross Revenue Disclosure Most Recent Reportable Year

Item 6a Enter ‘Y’ if the Applicant and any predecessors-in-interest were in existence and had gross revenues for the most recent reportable year. If ‘Y’, complete Items 6b and 6c. Enter ‘N’ if the Applicant and any predecessors-in-interest were not in existence for the most recent reportable year and explain why in an attachment.

One Year Prior to Most Recent Reportable Year

Item 7a Enter ‘Y’ if the Applicant and any predecessors-in-interest were in existence and had gross revenues for one year prior to the most recent reportable year. If ‘Y’, complete Items 7b and 7c. Enter ‘N’ if the Applicant and any predecessors-in-interest were not in existence for one year prior to the most recent reportable year and explain why in an attachment.

Two Years Prior to Most Recent Reportable Year

Item 8a Enter ‘Y’ if the Applicant and any predecessors-in-interest were in existence and had gross revenues for two years prior to the most recent reportable year. If ‘Y’, complete Items 8b and 8c. Enter ‘N’ if the Applicant and any predecessors-in-interest were not in existence for two years prior to the most recent reportable year and explain why in an attachment.

Average Gross Revenue

Item 9 The Universal Licensing System will calculate the average gross revenue for the reported years provided in Items 6, 7 and 8. Asset Disclosure

Item 10 Enter the total assets disclosed as of the application filing date.

Financial Statements

Item 11 Check if the Applicant used audited financial statements or unaudited financial statements prepared in accordance with Generally Accepted Accounting Principles (GAAP) and certified by Applicant’s chief financial officer or the equivalent.

Revenue and Asset Information for Each Disclosable Interest Holder (DIH)

Item 12 Select the proper block to Add, Modify, or Delete a Disclosable Interest Holder (DIH). If Adding, complete Items 15 through 21. If Modifying, enter only the items changed. If Deleting, complete the Entity Name or the Individual Name and the FCC Registration Number (FRN) of the DIH. Modify and Delete are used for Amendments of a previously filed application. If necessary, attach additional copies of this page to list more DIHs.

Disclosable Interest Holder

Item 13 Select the proper block for either Entity Name or Individual name of the Disclosable Interest Holder (DIH) and provide Entity Name or Individual name and the FCC Registration Number (FRN) of the DIH.

Gross Revenue Disclosure Most Recent Reportable Year

Item 14a Enter ‘Y’ if the Disclosable Interest Holder (DIH) and any predecessors-in-interest were in existence and had gross revenues for the most recent reportable year. If ‘Y’, complete Items 14b and 14c. Enter ‘N’ if the DIH and any predecessors-in-interest were not in existence for the most recent reportable year and explain why in an attachment.

One Year Prior to Most Recent Reportable Year

Item 15a Enter ‘Y’ if the Disclosable Interest Holder (DIH) and any predecessors-in-interest were in existence and had gross revenues for one year prior to the most recent reportable year. If ‘Y’, complete Items 15b and 15c. Enter ‘N’ if the DIH and any predecessors-in-interest were not in existence for one year prior to the most recent reportable year and explain why in an attachment.

Two Years Prior to Most Recent Reportable Year

Item 16a Enter ‘Y’ if the Disclosable Interest Holder (DIH) and any predecessors-in-interest were in existence and had gross revenues for two years prior to the most recent reportable year. If ‘Y’, complete Items 16b and 16c. Enter ‘N’ if the DIH and any predecessors-in-interest were not in existence for two years prior to the most recent reportable year and explain why in an attachment.

Average Gross Revenue

Item 17 The Universal Licensing System will calculate the average gross revenue for the reported years provided in Items 14, 15 and 16.

Asset Disclosure

Item 18 Enter the total assets disclosed as of the application filing date.

Financial Statements

Item 19 Check if the Disclosable Interest Holder (DIH) used audited financial statements or unaudited financial statements prepared in accordance with Generally Accepted Accounting Principles (GAAP) and certified by the DIH’s chief financial officer or the equivalent.

Revenue and Asset Information for Each Affiliate

Item 20 Select the proper block to Add, Modify, or Delete an Affiliate. If Adding, complete Items 21 through 27. If Modifying, enter only the items changed. If Deleting, complete the Entity Name or the Individual Name and the FCC Registration Number (FRN) of the Affiliate. Modify and Delete are used for Amendments of a previously filed application. If necessary, attach additional copies of this page to list more Affiliates.

Affiliate

Item 21 Select the proper block for either Entity Name or Individual name of the Affiliate and provide Entity Name or Individual name and the FCC Registration Number (FRN) of the Affiliate.

Gross Revenue Disclosure Most Recent Reportable Year

Item 22a Enter ‘Y’ if the Affiliate and any predecessors-in-interest were in existence and had gross revenues for the most recent reportable year. If ‘Y’, complete Items 22b and 22c. Enter ‘N’ if the Affiliate and any predecessors-in-interest were not in existence for the most recent reportable year and explain why in an attachment.

One Year Prior to Most Recent Reportable Year

Item 23a Enter ‘Y’ if the Affiliate and any predecessors-in-interest were in existence and had gross revenues for one year prior to the most recent reportable year. If ‘Y’, complete Items 23b and 23c. Enter ‘N’ if the Affiliate and any predecessors-in-interest were not in existence for one year prior to the most recent reportable year and explain why in an attachment.

Two Years Prior to Most Recent Reportable Year

Item 24a Enter ‘Y’ if the Affiliate and any predecessors-in-interest were in existence and had gross revenues for two years prior to the most recent reportable year. If ‘Y’, complete Items 24b and 24c. Enter ‘N’ if the Affiliate and any predecessors-in-interest were not in existence for two years prior to the most recent reportable year and explain why in an attachment.

Average Gross Revenue

Item 25 The Universal Licensing System will calculate the average gross revenue for the reported years in Items 22, 23 and 24.

Asset Disclosure

Item 26 Enter the total assets disclosed as of the application filing date.

Financial Statements

Item 27 Check if the Affiliate used audited financial statements or unaudited financial statements prepared in accordance with Generally Accepted Accounting Principles (GAAP) and certified by the Affiliate’s chief financial officer or the equivalent.

Closed Bidding/Small Business Bidding Credit Eligibility

Total Gross Revenues for Most Recent Reportable Year

Item 28 The Universal Licensing System will calculate the total gross revenue for the most recent reportable year and the year-end date.

Total Revenues for One Year Prior to Most Recent Reportable Year

Item 29 The Universal Licensing System will calculate the total gross revenue for one year prior to most recent reportable year and the year-end date.

Total Revenues for Two Years Prior to Most Recent Reportable Year

Item 30The Universal Licensing System will calculate the total gross revenue for two years prior to most recent reportable year and the year-end date.

Total Aggregate Average Gross Revenues for Small Business Bidding Credit Designated Entity

Item 31 The Universal Licensing System will calculate the aggregate average gross revenue for the Small Business Bidding Credit designated entity.

Total Aggregate Average Gross Revenues for Closed Bidding

Item 32 The Universal Licensing System will calculate the aggregate average gross revenue for the closed bidding.

Total Assets Disclosure

Item 33 The Universal Licensing System will calculate the total assets for the closed bidding.

Rural Service Provider Bidding Credit Eligibility

Item 34 If the Applicant (Assignee/Transferee) is seeking a Rural Service Provider (RSP) bidding credit, provide in an exhibit the following information:

a) for the Applicant, submit the combined number of commercial communications service subscribers to wireless, wireline, broadband, and cable services that the Applicant serves and provide a list of the name(s) and the Federal Information Processing Standard (FIPS) number(s) for each county in which the Applicant has at least one commercial wireless, wireline, broadband, or cable subscriber;

b) for each of the Applicant's Affiliates, Controlling Interests, and the Affiliates of its Controlling Interests, submit the individual or entity’s name, its FCC Registration Number (FRN), its relationship to the Applicant, and its combined number of commercial communications service subscribers to wireless, wireline, broadband, and cable services. For each of the Applicant's Affiliates, Controlling Interests, and the Affiliates of its Controlling Interests, also provide a list of the name(s) and the FIPS number(s) for each county in which it has at least one commercial wireless, wireline, broadband, or cable subscriber;

c) if neither the Applicant, nor any of its Affiliates, its Controlling Interests, or the Affiliates of its Controlling Interests have at least one wireless, wireline, broadband, or cable subscriber in a market for which the Applicant is applying for a license, list the market(s) in which the Applicant, its Affiliates, its Controlling Interests, and the Affiliates of its Controlling Interests have no such subscribers;

d) a detailed explanation demonstrating that: (i) the Applicant is in the business of providing commercial communications services; (ii) the Applicant serves predominantly rural areas; and (iii) the primary focus of the Applicant’s business activity is the provision of services to rural areas (defined as counties with a population density of 100 or fewer persons per square mile); and

e) if the Applicant is an existing rural partnership that was providing service as of July 16, 2015, provide a detailed explanation demonstrating that each member of the partnership is independently eligible for the RSP bidding credit by providing, with respect to each member of the partnership, the same information as is required in a-d above.

Subscriber counts should be current as of the date of filing this application. The Applicant, and other reporting entities, should count a subscriber only once even if that subscriber receives more than one service from the Applicant or entity. For example, a subscriber receiving both wireline service and broadband from the Applicant would be counted as a single subscriber of the Applicant.

FIPS numbers are available from the US Census Bureau and identified by the Commission as needed (see, e.g., Wireless Telecommunications Bureau Provides Details about Partial Economic Areas, GN Docket No. 12-268, Public Notice, 29 FCC Rcd 6491, 6502, Appx. B (2014)).

Instructions for Schedule for Defined Geographic Areas To Be Partitioned or for Spectrum To Be Disaggregated

FCC Form 603, Schedule B

FCC Form 603 Schedule B is a supplementary schedule. Complete this Schedule when an Assignment involves the partitioning or disaggregation of a geographic-area license. Complete a separate schedule for each partitioned area or if additional space is needed to depict the spectrum that is being disaggregated.

Item 1 Enter the Call Sign of the license that is to be partitioned or disaggregated.

Partitioned Area

Item 2 Enter the partitioned area if the partitioned area involves FCC-defined geographic boundaries (i.e., FCC licensing boundaries (Major Trading Areas (MTAs), Basic Trading Areas (BTAs), etc.) or county boundaries.

In some cases, more than one geographic area exists with the same name in the same state (i.e., an independent city with the same name as a county in the same state). To partition these independent cities, you must enter its 5 digit FIPS code (2-digit state FIPS code + 3-digit county FIPS code). For example, in Virginia there is a Fairfax County and a Fairfax City. Fairfax City is an independent city and is not affiliated with Fairfax County. To partition the city of Fairfax, you must enter its FIPS code, 51600, as shown in the table below. To partition the county of Fairfax, you could enter its FIPS code or ‘Fairfax, VA’. For a listing of FIPS codes, refer to http://www.census.gov/geo/reference/codes/cou.html. For information regarding electronic filings, please refer to DA 15-1250.

INDEPENDENT CITY NAME	FIPS CODE
Baltimore MD	24510
St. Louis, MO	29510
Bedford, VA	51515
Fairfax, VA	51600
Franklin, VA	51620
Richmond, VA	51760
Roanoke, VA	51770

Item 3 If the area to be partitioned is undefined (e.g., cannot be described using FCC-defined geographic boundaries or county boundaries), describe its periphery by completing Schedule C. Assign a unique number to each copy of Schedule C that is filed. Enter this number in both the Number field at the top of Schedule C and Item 3 on Schedule B.

Item 4 Enter the population of the partitioned area.

Spectrum Disaggregated

Item 5 Authorized spectrum blocks can be disaggregated by assigning one or more frequency blocks. To assign a frequency block, enter its lower value in MHz in the Lower Frequency field and enter its upper value in MHz in the Upper Frequency field. In this table, complete as many entries as you need to depict the disaggregation completely. For Priority Access Licenses (Radio Service PL), enter the lower and upper limits of the spectrum to be leased. The difference between the upper limit and the lower limit represents the amount of bandwidth disaggregated from the Priority Access License. Specific operating frequencies will be assigned by the SAS Administrator prior to commencing operations.

Coverage Requirements - Partitioning

Item 6 Check the selection that indicates which coverage requirements have been agreed upon by the partitioner and partitionee.

Coverage Requirements - Disaggregation

Item 7 Check the selection that indicates which coverage requirements have been agreed upon by the disaggregator and disaggregatee.

Relocation of Incumbent Licensees

Item 8 In certain services, licensees must meet certain obligations to relocate incumbent licensees. If the proposed geographic partitioning, spectrum disaggregation, or combination of both involves any incumbent relocation requirements, enter ‘Y’. If ‘Y’, attach an exhibit with a certification regarding which party will meet these requirements, except as stated in service-specific rules.

Instructions for Schedule for Undefined Geographic Areas To Be Partitioned FCC Form 603, Schedule C

FCC Form 603 Schedule C is a supplementary schedule. This schedule must be completed and attached if an undefined area is to be partitioned, as specified by Item 3 on Schedule B. Complete and attach a copy of Schedule C for each Call Sign that is being partitioned or disaggregated. If multiple undefined areas are requested, each undefined area should have a corresponding Schedule C.

This schedule further delineates geographic areas that have not been defined by the FCC. It is used to enter the coordinates of locations that describe the periphery of a geographic area to be partitioned. Specifically, enter up to 300 pairs of latitude/longitude coordinates, one pair for every 3 degrees azimuth around the periphery (you may use additional copies of Page 2 if more space is needed). Coordinates of the specified locations must be referenced to the North American Datum of 1983 (NAD83).

Note: If the area is a defined geographic shape, the Applicants can provide fewer than 300 coordinates, in which case the FCC will assume that these coordinate points are joined by straight lines. For example, a rectangle can be described by four coordinates, a hexagon by six coordinates, and so on.

Number: At the top of this schedule, enter the same number that has been specified in Item 3 of Schedule B.

Latitude: In this column, enter the latitudes of locations using the format DD-MM-SS.S-D, where the degrees (DD) term can have a value in the range of 0 to 72, minutes (MM) can range from 0 to 59, seconds (SS.S) can range from 0 to 59.9, and the direction (D) term is either N for North or S for South.

Longitude: In this column, enter the corresponding longitudes of locations using the format DDD-MM-SS.S-D, where the degrees (DDD) term can have a value in the range of 64 to 180, minutes (MM) can range from 0 to 59, seconds (SS.S) can range from 0 to 59.9, and the direction (D) term is either E for East or W for West.

Instructions for Schedule for Notification of Consummation of an Assignment of Authorization or a Transfer of Control

FCC Form 603, Schedule D

FCC Form 603 Schedule D is a supplementary schedule. This schedule is used to notify the FCC that, within the required time period, either an Assignment of Authorization or a Transfer of Control has been consummated. The FCC Form 603 Main Form must be filed in conjunction with this schedule and signed by either the Assignee (Assignment of Authorization) or the Transferee (Transfer of Control).

Item 1 Provide the file number of the previously consented to Assignment of Authorization or Transfer of Control application.

Item 2 Provide the date that the previously consented to Assignment of Authorization or Transfer of Control was actually consummated.

Instructions for Schedule for Request for Extension of Time To Consummate an Assignment of Authorization or a Transfer of Control

FCC Form 603, Schedule E

FCC Form 603 Schedule E is a supplementary schedule. This schedule is used to request additional time to consummate an Assignment of Authorization or a Transfer of Control. The FCC Form 603 Main Form must be filed in conjunction with this schedule and signed by either the Assignor (Assignment of Authorization) or the Transferor (Transfer of Control).

Item 1 Provide the file number of the previously consented to Assignment of Authorization or Transfer of Control application.

Item 2 Provide the requested consummation date for the Assignment of Authorization or Transfer of Control application. In addition, attach an exhibit explaining the reason for the extension request.

Appendix I

STATE TABLE

Abbreviations for States, Jurisdictions, and Areas

AL	Alabama	ND	North Dakota
AK	Alaska	OH	Ohio
AZ	Arizona	OK	Oklahoma
AR	Arkansas	OR	Oregon
CA	California	PA	Pennsylvania
CO	Colorado	RI	Rhode Island
CT	Connecticut	SC	South Carolina
DE	Delaware	SD	South Dakota
DC	District of Columbia	TN	Tennessee
FL	Florida	TX	Texas
GA	Georgia	UT	Utah
GM	Gulf of Mexico	VT	Vermont
HI	Hawaii	VA	Virginia
ID	Idaho	WA	Washington
IL	Illinois	WV	West Virginia
IN	Indiana	WI	Wisconsin
IA	Iowa	WY	Wyoming
KS	Kansas
KY	Kentucky	AS	American Samoa
LA	Louisiana	GU	Guam
ME	Maine	MP	Northern Mariana Islands
MD	Maryland	PR	Puerto Rico
MA	Massachusetts	UM	U.S. Territories: (Baker Island, Howland Island,
MI	Michigan		Jarvis Island, Johston Atoll, Kingman Reef, Midway
MN	Minnesota		Island, Navassa Island, Palmyra Atoll and Wake
MS	Mississippi		Island)
MO	Missouri	VI	Virgin Islands
MT	Montana
NE	Nebraska	AA	Armed Forces-Americas (excluding Canada)
NV	Nevada	AE	Armed Forces-(Europe, Middle East, Africa,
NH	New Hampshire		Canada)
NJ NM	New Jersey New Mexico	AP	Armed Forces-Pacific
NY	New York
NC	North Carolina

FCC Form 603 FCC Application for Assignments of Authorization

Main Form or Transfers of Control: Wireless Telecommunications Bureau

And Public Safety and Homeland Security Bureau Not Approved by OMB See instructions for public burden estimate

General Information

1) Application Purpose (Select only one) ( ) AA - Assignment of Authorization AM - Amendment NT - Required Notification (For Consummation of an Assignment or Transfer) TC - Transfer of Control WD - Withdrawal EX - Request for Extension of Time To Consummate an Assignment or Transfer)
2) If this application is for an Amendment (AM) or Withdrawal (WD), enter the File Number of the pending or consented to application currently on file with the FCC.	File Number:
3a) Is this application for Assignment of Authorization or Transfer of Control part of a series of applications involving other wireless license(s) held by the Licensee, affiliates of the Licensee (e.g., parents, subsidiaries, or commonly-controlled entities), or third parties that are not included on this application and for which Commission approval or notification is required?	( ) Yes No
3b) If the answer to 3a is ‘Y’, is this filing the lead application?	( ) Yes No
3c) If the answer to 3b is ‘N’, provide the File Number of the lead application.	File Number:
3d) Does this transaction for Assignment of Authorization or Transfer of Control involve the assignment or transfer of non-wireless licenses/authorizations for which Commission approval or notification is required?	( ) Yes No
4) Are attachments (other than associated schedules) being filed with this application?	( ) Yes No

Fees and Waivers

5a) Is the Applicant exempt from FCC application fees? If ‘Y’, attach an exhibit demonstrating how the Applicant is exempt from FCC application fees.	( ) Yes No
5b) Is a waiver/deferral of the FCC application fees being requested and the application fees are not being submitted in conjunction with this application? If ‘Y’, attach a date-stamped copy of the request for waiver/deferral of the FCC application fees.	( ) Yes No
6a) Does this application include a request for waiver of the Commission’s Rules (other than a request for application fee waivers)? If ‘Y’, attach an exhibit specifying the rule section(s) for which a waiver is being requested and including a justification for the waiver request.	( ) Yes No
6b) If 6a is ‘Y’, enter the number of rule sections involved.	Number of Rule Sections:

Additional Transaction Information

7a) Has this application for Assignment of Authorization or Transfer of Control already occurred?	( ) Yes No
7b) If the response to Item 7a is ‘Y’, provide the date the event occurred:	(MM/DD/YYYY) / /
8) The Assignment of Authorization or Transfer of Control is:	( ) Voluntary ( ) Involuntary
9a) Is this application a pro forma Assignment of Authorization or Transfer of Control?	( ) Yes No
9b) If Item 9a is ‘Y’, is this a post-consummation notification that is being filed under the Commission’s forbearance procedures pursuant to Section 1.948(c)(1) of the Commission’s Rules?	( ) Yes No
10a) Does this application involve the partitioning and/or disaggregation of geographic-area licenses? If ‘Y’, complete Schedule B and, if applicable, Schedule C.	( ) Yes No
10b) If 10a is ‘N’, does this application involve the partial assignment of site-based licenses?	( ) Yes No

Designated Entity Information (If 12a or 12b is ‘Y’, Schedule A is required to be completed.)

12a) Enter ‘Y’ if this application for Assignment of Authorization or Transfer of Control involve any licenses that were awarded with bidding credits within the last five years. Otherwise, enter ‘N’. The initial grant date is the date that the license was originally granted by the Commission after an auction, even if the license was acquired in the secondary market. The initial grant date is not the date on which the Commission granted an assignment or transfer of control of the license. If the response to this item is ‘Y’, the licenses may be subject to the FCC’s unjust enrichment rules, and the Applicant should answer relevant bidding credit questions. See Section 1.2111 of the Commission’s Rules.

( ) Yes No

12b) Does this application for Assignment of Authorization or Transfer of Control involve any licenses that were originally granted pursuant to closed bidding within the last five years? If the response to this item is ‘Y’, the license may be subject to assignment or transfer restrictions, and the Applicant should answer relevant closed bidding questions. See Sections 24.709 and 24.839 of the Commission’s Rules.

( ) Yes No

Competition Related Information

13) Does this application for Assignment of Authorization or Transfer of Control involve a license(s) that may be used for interconnected mobile voice and/or data services that would, if assigned or transferred, create a geographic overlap with another license(s) in which the Assignee/Transferee already holds attributable interests, as defined in Section 20.22(b) of the Commission’s Rules, either as a licensee or spectrum lessee/sublessee, and that also could be used to provide interconnected mobile voice and/or data services? If ‘Y’, specify in an exhibit all geographic areas/markets (e.g., BTA, CMA, county, etc.) where there are spectrum overlaps and the total amount of spectrum that the Assignee/Transferee will hold and/or lease in each geographic area/market.

( ) Yes No

14) If the answer to Item 13 is ‘Yes,’ would/does this application for Assignment of Authorization or Transfer of Control reduce the number of entities providing service in the affected market(s)?

( ) Yes No

Broadband Radio Service and Educational Broadband Service Information

15a) Will the requested facilities be used to provide multichannel video programming service?	( ) Yes No
15b) If 15a is ‘Y’, does the Assignee/Transferee operate, control, or have an attributable interest (as defined in Section 27.1202 of the Commission’s Rules) in a cable television system whose franchise area is located within the geographic area of the requested facilities? If ‘Y’, provide an exhibit explaining how the Assignee/Transferee complies with Section 27.1202 of the Commission’s Rules or request a waiver of that rule pursuant to Commission Rules. If a waiver of the Commission’s Rule(s) is being requested, 6a must be answered ‘Y’.	( ) Yes No
16) Does the Assignee/Transferee comply with the programming requirements contained in Section 27.1203 of the Commission’s Rules? If ‘N’, provide an exhibit explaining how the Assignee/Transferee complies with Section 27.1203 of the Commission’s Rules or request a waiver of that rule pursuant to Commission Rules. If a waiver of the Commission’s Rule(s) is being requested, 6a must be answered ‘Y’.	( ) Yes No

600 MHz Band Information

17) Does the Assignment or Transfer involve any licenses in the 600 MHz Band initially granted in the last six years that would, if assigned/transferred, create a geographic overlap with another licenses(s) in which the Assignee/Transferee already holds attributable interests, either as a licensee or Assignee/Transferee, and that would result in the Assignee/Transferee holding an attributable interest in one-third or more of the total suitable and available below-1-GHz spectrum as calculated on a county-by-county population-weighted basis in the relevant license area, utilizing 2010 U.S. Census data? The initial grant date is the date that the license was originally granted by the Commission after an auction, even if the license was acquired in the secondary market. The initial grant date is not the date on which the Commission granted an assignment or transfer of control of the license. If the response to this item is ‘Y’, this application for Assignment or Transfer application must be part of an exchange of 600 MHz band spectrum in the same market(s) or must be a pro forma Assignment or Transfer. If ‘Y’, provide an exhibit detailing the proposed exchange of 600 MHz band spectrum in the same market(s), including a list of all file numbers for applications associated with the proposed exchange.	(	) Yes	No
18) Does the Assignment or Transfer involve any licenses that were initially granted as reserved spectrum licenses in the 600 MHz Band in the last six years? Otherwise, enter ‘N’. The initial grant date is the date that the license was originally granted by the Commission after an auction, even if the license was acquired in the secondary market. The initial grant date is not the date on which the Commission granted an assignment or transfer of control of the license. If ‘Y’, provide an exhibit demonstrating how the Assignee/Transferee would have qualified to bid on that reserved spectrum license(s) in Auction 1002 as of the FCC Form 175 filing deadline (February 10, 2016) for Auction 1002, the forward auction of the Broadcast Incentive Auction.	(	) Yes	No

Assignor/Licensee Information

19) Assignor/Licensee is a(n): (Select One) ( ) Individual ( ) Unincorporated Association ( ) Trust ( ) Government Entity ( ) Corporation ( ) Limited Liability Company ( ) General Partnership ( ) Limited Partnership ( ) Limited Liability Partnership ( ) Other:
20) FCC Registration Number (FRN):
21) First Name (if individual):			MI:		Last Name:			Suffix:
22) Legal Entity Name (if not an individual):
23) Attention To:
24) P.O. Box:	And /Or	25) Street Address:
26) City:						27) State:	28) Zip Code:
29) Telephone Number:				30) Fax Number:
31) E-Mail Address:

32) Demographics of Assignor/Licensee (Optional):

Race: ( )American Indian or Alaska Native ( )Asian ( )Black or African-American ( )Native Hawaiian or Other Pacific Islander ( )White

Ethnicity: ( )Hispanic or Latino ( )Not Hispanic or Latino

Gender: ( )Male ( )Female

Assignor/Licensee Contact Representative

33) First Name:			MI:		Last Name:			Suffix:
34) Company Name:
35) Attention To:
36) P.O. Box:	And /Or	37) Street Address:
38) City:						39) State:	40) Zip Code:
41) Telephone Number:				42) Fax Number:
43) E-Mail Address:

Transferor Information (for Transfers of Control only)

44) Transferor is a(n): (Select One) ( ) Individual ( )Unincorporated Association ( )Trust ( )Government Entity ( )Corporation ( )Limited Liability Company ( ) General Partnership ( ) Limited Partnership ( ) Limited Liability Partnership ( ) Other:
45) FCC Registration Number (FRN):
46) First Name (if individual):			MI:		Last Name:			Suffix:
47) Legal Entity Name (if not an individual):
48) Attention To:
49) P.O. Box:	And /Or	50) Street Address:
51) City:						52) State:	53) Zip Code:
54) Telephone Number:				55) Fax Number:
56) E-Mail Address:

57) Demographics of Transferor (Optional):

Race: ( )American Indian or Alaska Native ( )Asian ( )Black or African-American ( )Native Hawaiian or Other Pacific Islander ( )White

Ethnicity: ( )Hispanic or Latino ( )Not Hispanic or Latino

Gender: ( )Male ( )Female

Transferor Contact Representative

58) First Name:			MI:		Last Name:			Suffix:
59) Company Name:
60) Attention To:
61) P.O. Box:	And /Or	62) Street Address:
63) City:						64) State:	65) Zip Code:
66) Telephone Number:				67) Fax Number:
68) E-Mail Address:

Assignee/Transferee Information

69) Assignee/Transferee is a(n): (Select One) ( ) Individual ( )Unincorporated Association ( )Trust ( )Government Entity ( )Corporation ( )Limited Liability Company ( ) General Partnership ( ) Limited Partnership ( ) Limited Liability Partnership ( ) Other:
70) FCC Registration Number (FRN):
71) First Name (if individual):			MI:		Last Name:			Suffix:
72) Legal Entity Name (if not an individual):
73) Attention To:
74) Real Party in Interest FCC Registration Number (FRN):
75) Name of Real Party in Interest:
76) P.O. Box:	And /Or	77) Street Address:
78) City:						79) State:	80) Zip Code:
81) Telephone Number:				82) Fax Number:
83) E-Mail Address:

84) Demographics of Assignee/Transferee (Optional):

Race: ( )American Indian or Alaska Native ( )Asian ( )Black or African-American ( )Native Hawaiian or Other Pacific Islander ( )White

Ethnicity: ( )Hispanic or Latino ( )Not Hispanic or Latino

Gender: ( )Male ( )Female

Assignee/Transferee Contact Representative (if other than Assignee/Transferee)

( ) Check here if same as Assignee/Transferee.

85) First Name:			MI:		Last Name:			Suffix:
86) Company Name:
87) Attention To:
88) P.O. Box:	And /Or	89) Street Address:
90) City:						91) State:	92) Zip Code:
93) Telephone Number:				94) Fax Number:
95) E-Mail Address:

Ownership Disclosure Information

96a) Is the Assignee/Transferee required to file FCC Form 602, Ownership Disclosure Information for the Wireless Telecommunications Services?	( ) Yes No
96b) If 94a is ‘Y’, provide the File Number of the FCC Form 602 that is required to be submitted in conjunction with this application or is already on file with the FCC.	File Number:

Alien Ownership (If any answer is ‘Y”, provide an attachment explaining the circumstances. In preparing the attachment, refer to the Main Form Instructions for the “Alien Ownership Questions”.)

97) Is the Assignee/Post-transfer Licensee a foreign government or the representative of any foreign government?	( ) Yes No
98) Is the Assignee/Post-Transfer Licensee an alien or the representative of an alien?	( ) Yes No
99) Is the Assignee/Post-Transfer Licensee a corporation organized under the laws of any foreign government?	( ) Yes No
100) Is the Assignee/Post-Transfer Licensee 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
101a) Is the Assignee/Post-Transfer Licensee 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 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
101b) If the answer to 100 or 101a is ‘Y’ select one of the choices below. The Assignee or Post-Transfer Licensee is exempt from the provisions of Section 310(b). It is not necessary to file a petition for declaratory ruling if the Assignee or Post-Transfer Licensee includes in the attachment required by Item 100 or Item 101a a showing that the subject License(s) is exempt from the provisions of Section 310(b). The Assignee or Post-Transfer Licensee has received a declaratory ruling(s) approving its foreign ownership, and the application involves only the acquisition of additional spectrum for the provision of a wireless service in a geographic coverage area for which the Assignee or Post-Transfer Licensee has been previously authorized. If checked, include in the attachment required by Item 100 or Item 101a the citation(s) of the applicable declaratory ruling(s) by DA/FCC number, the FCC Record citation, if available, release date, and a statement that there has been no change in the foreign ownership of the Assignee or Post- Transfer Licensee since the issuance of its ruling. The Assignee or Post-Transfer Licensee: (i) has received a declaratory ruling(s) approving its foreign ownership, but is not able to make the certification specified immediately above; or (ii) is an “affiliate” of a Licensee or Lessee/SubLessee that received a declaratory ruling(s) under Section 1.990(a) of the Commission’s Rules, 47 C.F.R. § 1.990(a), and is relying on the affiliate’s ruling for purposes of filing this application as permitted under the affiliate’s ruling and Section 1.994(b) of the Rules, 47 C.F.R. § 1.994(b). If checked, and if the Assignee or Post-Transfer Licensee received its declaratory ruling(s) on or after August 9, 2013, include in the attachment required by Item 100 or Item 101a the citation(s) of the Assignee or Post-Transfer Licensee’s declaratory ruling(s) by DA/FCC number, the FCC Record citation, if available, release date, and a statement that the Assignee or Post-Transfer Licensee is in compliance with the terms and conditions of its ruling and with the Commission’s Rules. If checked, and if the Assignee or Post-Transfer Licensee received its declaratory ruling(s) prior to August 9, 2013, include in the attachment required by Item 101a a copy of a petition for declaratory ruling filed contemporaneously with the Commission to extend the Assignee or Post- Transfer Licensee’s existing ruling(s) to cover the same radio service(s) and geographic coverage area(s) involved in the application. Alternatively, the Assignee or Post-Transfer Licensee may request a new declaratory ruling pursuant to Section 1.990(a) of the Commission’s Rules, 47 C.F.R. § 1.990(a). Petitions for declaratory ruling may be filed electronically on the Internet through the International Bureau Filing System (IBFS) (with a copy attached hereto). If checked, and if the Assignee or Post-Transfer Licensee is relying on an affiliate’s ruling for purposes of filing this application/notification, include in the attachment required by Item 100 or Item 101a the citation(s) of the applicable declaratory ruling(s) by DA/FCC number, the FCC Record citation, if available, release date, and a statement that the Assignee or Post-Transfer Licensee is in compliance with the terms and conditions of the named affiliate(s)’s ruling and with the Commission’s Rules. The Assignee or Post-Transfer Licensee must also include a certification of compliance signed by the named affiliate or other qualified entity as specified in Section 1.994(b) of the Rules, 47 C.F.R. § 1.994(b). See Main Form Instructions for Items 100 or 101a, as applicable. The Assignee or Post-Transfer Licensee has not received a declaratory ruling approving its foreign ownership and is requesting a declaratory ruling under Section 1.990(a) of the Commission’s Rules, 47 C.F.R. § 1.990(a), in a petition filed contemporaneously with the Commission. If checked, include in the attachment required by Item 100 or 101a a copy of the petition for declaratory ruling filed contemporaneously with the Commission pursuant to Section 1.990(a) of the Commission’s Rules, 47 C.F.R. § 1.990(a). Petitions for declaratory ruling may be filed electronically on the Internet through the International Bureau Filing System (IBFS) (with a copy attached hereto).

Basic Qualification Information

102) Has the Assignee/Transferee or any party to this application had any FCC station authorization, license or construction permit revoked or had any application for an initial, modification, or renewal of FCC station authorization, license, or construction permit denied by the Commission? If ‘Y’, attach an exhibit explaining the circumstances.	( ) Yes No
103) Has the Assignee/Transferee or any party to this application, or any party directly or indirectly controlling the Assignee/Transferee ever been convicted of a felony by any state or federal court? If ‘Y’, attach an exhibit explaining the circumstances.	( ) Yes No
104) Has any court finally adjudged the Assignee/Transferee, or any party directly or indirectly controlling the Assignee/Transferee guilty of unlawfully monopolizing or attempting unlawfully to monopolize radio communication, directly or indirectly, through control of manufacture or sale of radio apparatus, exclusive traffic arrangement, or any other means or unfair methods of competition? If ‘Y’, attach an exhibit explaining the circumstances.	( ) Yes No

Assignor/Transferor Certification Statements

1) The Assignor/Transferor certifies either that (1) the authorization will not be assigned or that control of the license(s) will not be transferred until the consent of the Federal Communications Commission has been given, or (2) prior Commission consent is not required because the transaction is subject to streamlined notification procedures for pro forma assignments and transfers by telecommunications carriers. See Section 1.948(c) (1) of the Commission’s Rules.
2) The Assignor/Transferor certifies that all statements made in this application and in the exhibits, attachments, or documents incorporated by reference are material, are part of this application, and are true, complete, correct, and made in good faith.
3) The Assignor/Transferor certifies that it is not in default on any payment for Commission licenses and that it is not delinquent on any non-tax debt owed to any federal agency.
Typed or Printed Name of Party Authorized to Sign
105) First Name:	MI:	Last Name:	Suffix:
106) Title:
Signature:			107) Date:
FAILURE TO SIGN THIS APPLICATION MAY RESULT IN DISMISSAL OF THE APPLICATION AND FORFEITURE OF ANY FEES PAID.
WILLFUL FALSE STATEMENTS MADE ON THIS FORM OR ANY ATTACHMENTS 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).

Assignee/Transferee Certification Statements

1) The Assignee/Transferee certifies either that (1) the authorization(s) will not be assigned or that control of the license(s) will not be transferred until the consent of the Federal Communications Commission has been given, or (2) prior Commission consent is not required because the transaction is subject to streamlined notification procedures for pro forma assignments and transfers by telecommunications carriers. See Section 1.948(c)(1) of the Commission’s Rules.

2) The Assignee/Transferee 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.

3) The Assignee/Transferee certifies that grant of this application would not cause the Assignee or Transferee to be in violation of any pertinent cross- ownership or attribution rules.*

*If the Assignee/Transferee has sought a waiver of any such rule in connection with this application, it may make this certification subject to the outcome of the waiver request.

4) The Assignee/Transferee agrees to assume all obligations and abide by all conditions imposed on the Assignor/Transferor under the subject authorization(s), unless the Federal Communications Commission pursuant to a request made herein otherwise allows, except for liability for any act done by, or any right accrued by, or any suit or proceeding had or commenced against the Assignor/Transferor prior to this assignment/transfer.

5) The Assignee/Transferee certifies that all statements made in this application and in the exhibits, attachments, or documents incorporated by reference are material, are part of this application, and are true, complete, correct, and made in good faith.

6) The Assignee/Transferee certifies that neither it nor any other party to the application is subject to a denial of Federal benefits pursuant to Section 5301 of the Anti-Drug Abuse Act of 1988, 21 U.S.C. § 862, because of a conviction for possession or distribution of a controlled substance. This certification does not apply to applications filed in services exempted under Section 1.2002(c) of the Commission’s Rules. See Section 1.2002(b) of the Commission’s Rules for the definition of "party to the application" as used in this certification.

7) The Assignee/Transferee certifies that it is not in default on any payment for Commission licenses and that it is not delinquent on any non-tax debt owed to any federal agency.

8) The Assignee/Transferee certifies that it and all of the related individuals and entities required to be disclosed on this application and FCC Form 602 (FCC Ownership Disclosure Information for the Wireless Telecommunications Services) are not person(s) who have been, for reasons of national security, barred by any agency of the Federal Government from bidding on a contract, participating in an auction, or receiving a grant. This certification applies only to applications for licenses for spectrum that is required by Sections 6103, 6401-6403 of the Middle Class Tax Relief and Job Creation Act of 2012, codified at 47 U.S.C. §§ 309, 1413, 1451-1452, to be assigned by a system of competitive bidding under 47

U.S.C. § 309(j).

Typed or Printed Name of Party Authorized to Sign

108) First Name:	MI:	Last Name:	Suffix:
109) Title:
Signature:			110) Date:
FAILURE TO SIGN THIS APPLICATION MAY RESULT IN DISMISSAL OF THE APPLICATION AND FORFEITURE OF ANY FEES PAID.
WILLFUL FALSE STATEMENTS MADE ON THIS FORM OR ANY ATTACHMENTS 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).

Authorizations To Be Assigned or Transferred

111) Call Sign	112) Radio Service Code	113) Location Number	114) Path Number (Microwave only)	115) Frequency Number	116) Lower or Center Frequency (MHz)	117) Upper Frequency (MHz)	118) Constructed Yes / No

FCC Form 603	Schedule for Licensees that Received Bidding Credits	Not Approved by OMB
Schedule A		3060 - 0800
	or Involving Licenses Won in Closed Bidding	See Main Form instructions for public burden estimate

For Purposes of Schedule A, Applicant is defined as the Assignee (Assignment of Authorization) or the post-transaction Licensee (Transfers of Control)

Bidding Credits

1) Have the full amount of bidding credits awarded with regard to each of the subject license(s) been paid as part of unjust enrichment payment(s) in previous transaction(s)? If the response to Item 1 is ‘Y’, Item 2 is not required to be completed.	( ) Yes No
2a) With respect to each of the subject licenses, the Applicant: ( ) qualifies for the same designated entity benefits as the current Licensee ( ) qualifies for a designated entity benefits with a lower bidding credit percentage than the current Licensee ( ) does not qualify for any designated entity benefits The Applicant may request the same designated entity status as the current Licensee or a different designated entity status from the current Licensee, either as a small business as defined in Section 1.2110(f)(2) or as a rural service provider as defined in Section 1.2110(f)(4), but not both.
2b) If the Applicant states in Item 2a that it qualifies for the same designated entity benefit as the current Licensee or qualifies for a different designated entity status than the current Licensee, the Applicant qualifies for a (select one): ( ) small business bidding credit ( ___%) ( ) rural service provider bidding credit If the Applicant selects the small business bidding credit, complete the relevant revenue and asset questions. If the Applicant selects rural service provider bidding credit, complete the relevant rural service provider question. For either bidding credit, attach an exhibit that includes the information required by the Commission’s Rules, including any agreements, whether oral or written, that could affect the Applicant’s eligibility for designated entity benefits, including but not limited to partnership agreements, shareholder agreements, management agreements, spectrum leasing agreements, spectrum use agreements, spectrum resale (including wholesale) arrangements, and all agreements or arrangements establishing de facto and/or de jure control of the Applicant or of the subject licenses.

Closed Bidding Licenses

3) Have construction notifications been submitted as required by the Commission’s Rules for each of the subject licenses? If the response to Item 5 is ‘Y’, Item 6 is not required to be completed.	( ) Yes No
4) With respect to each of the subject licenses, the Applicant: ( ) qualifies for closed bidding ( ) does not qualify for closed bidding

Revenue and Asset Information for Applicant

5) Purpose (Check Modify if filing an Amendment application and changing the Revenue and Asset Information from what was provided on the original filing)

• Modify

Gross Revenue Disclosure Most Recent Reportable Year

6a) Were the Applicant and any predecessors-in-interest in existence for a full year of the relevant period? If ‘N’, explain why in an attachment.	( ) Yes No
If ‘Y’, provide the following information. 6b) Gross Revenues $ (Format: 99,999.99) 6c) Year-end Date: (Date Format: MM/DD/YYYY)

One Year Prior to Most Recent Reportable Year

7a) Were the Applicant and any predecessors-in-interest in existence for a full year of the relevant period? If ‘N’, explain why in an attachment.	( ) Yes No
If ‘Y’, provide the following information. 7b) Gross Revenues $ (Format: 99,999.99) 7c) Year-end Date: (Date Format: MM/DD/YYYY)

Two Years Prior to Most Recent Reportable Year

8a) Were the Applicant and any predecessors-in-interest in existence for a full year of the relevant period? If ‘N’, explain why in an attachment.	( ) Yes No
If ‘Y’, provide the following information. 8b) Gross Revenues $ (Format: 99,999.99) 8c) Year-end Date: (Date Format: MM/DD/YYYY)

Average Gross Revenue

9) Average Gross Revenue of Reported Years: $ (Format: 99,999.99)

Asset Disclosure

10) Total Assets as of Application Filing Date: $ (Format: 99,999.99)

Financial Statements

11. Audited or Unaudited (Check One)

    • The Applicant used audited financial statements.

      • The Applicant used unaudited financial statements prepared in accordance with Generally Accepted Accounting Principles (GAAP) and certified by the Applicant’s chief financial officer or the equivalent.

Revenue and Asset Information for Disclosable Interest Holder (DIH) (including each of Applicant’s Controlling Interests, and Affiliates of Its Controlling Interests).

12) Purpose (Select One)

• Add □ Modify □ Delete

13) Disclosable Interest Holder
Entity Name:				FCC Registration Number (FRN):
Individual Name: First	MI	Last	Suffix	FCC Registration Number (FRN):

Gross Revenue Disclosure Most Recent Reportable Year

14a) Were the Disclosable Interest Holder (DIH) and any predecessors-in-interest in existence for a full year of the relevant period? If ‘N’, explain why in an attachment.	( ) Yes No
If ‘Y’, provide the following information. 14b) Gross Revenues $ (Format: 99,999.99) 14c) Year-end Date: (Date Format: MM/DD/YYYY)

One Year Prior to Most Recent Reportable Year

15a) Were the Disclosable Interest Holder (DIH) and any predecessors-in-interest in existence for a full year of the relevant period? If ‘N’, explain why in an attachment.	( ) Yes No
If ‘Y’, provide the following information. 15b) Gross Revenues $ (Format: 99,999.99) 15c) Year-end Date: (Date Format: MM/DD/YYYY)

Two Years Prior to Most Recent Reportable Year

16a) Were the Disclosable Interest Holder (DIH) and any predecessors-in-interest in existence for a full year of the relevant period? If ‘N’, explain why in an attachment.	( ) Yes No
If ‘Y’, provide the following information. 16b) Gross Revenues $ (Format: 99,999.99) 16c) Year-end Date: (Date Format: MM/DD/YYYY)

Average Gross Revenue

17) Average Gross Revenue of Reported Years: $ (Format: 99,999.99)

Asset Disclosure

18) Total Assets as of Application Filing Date: $ (Format: 99,999.99)

Financial Statements

19. Audited or Unaudited (Check One)

    • The Disclosable Interest Holder (DIH) used audited financial statements.

    • The Disclosable Interest Holder (DIH) used unaudited financial statements prepared in accordance with Generally Accepted Accounting Principles (GAAP) and certified by the DIH’s chief financial officer or the equivalent.

Revenue and Asset Information for Affiliate

20. Purpose (Select One)

• Add □ Modify □ Delete

21) Affiliate
Entity Name:				FCC Registration Number (FRN):
Individual Name: First	MI	Last	Suffix	FCC Registration Number (FRN):

Gross Revenue Disclosure Most Recent Reportable Year

22a) Were the Affiliate and any predecessors-in-interest in existence for a full year of the relevant period? If ‘N’, explain why in an attachment.	( ) Yes No
If ‘Y’, provide the following information. 22b) Gross Revenues $ (Format: 99,999.99) 22c) Year-end Date: (Date Format: MM/DD/YYYY)

One Year Prior to Most Recent Reportable Year

23a) Were the Affiliate and any predecessors-in-interest in existence for a full year of the relevant period? If ‘N’, explain why in an attachment.	( ) Yes No
If ‘Y’, provide the following information. 23b) Gross Revenues $ (Format: 99,999.99) 23c) Year-end Date: (Date Format: MM/DD/YYYY)

Two Years Prior to Most Recent Reportable Year

24a) Were the Affiliate and any predecessors-in-interest in existence for a full year of the relevant period? If ‘N’, explain why in an attachment.	( ) Yes No
If ‘Y’, provide the following information. 24b) Gross Revenues $ (Format: 99,999.99) 24c) Year-end Date: (Date Format: MM/DD/YYYY)

Average Gross Revenue

25) Average Gross Revenue of Reported Years: $ (Format: 99,999.99)

Asset Disclosure

26) Total Assets as of Application Filing Date: $ (Format: 99,999.99)

Financial Statements

27. Audited or Unaudited (Check One)

    • The Affiliate used audited financial statements.

    • The Affiliate used unaudited financial statements prepared in accordance with Generally Accepted Accounting Principles (GAAP) and certified by the Affiliate’s chief financial officer or the equivalent.

Closed Bidding/Designated Entity Eligibility

Total Gross Revenues for Most Recent Reportable Year

Total Gross Revenues for One Year Prior to Most Recent Reportable Year

Total Gross Revenues for Two Years Prior to Most Recent Reportable Year

Total Aggregate Average Gross Revenues for Designated Entity

31) Aggregate Average Gross Revenue: $ (Format: 99,999.99)

Total Aggregate Average Gross Revenues for Closed Bidding

32) Aggregate Average Gross Revenue: $ (Format: 99999.99)

Total Assets Disclosure for Closed Bidding

33) Total Assets: $ (Format: 99,999.99)

Rural Service Provider Bidding Credit

34) Is the Applicant seeking a Rural Service Provider (RSP) bidding credit?

( ) Yes No

If ‘Y’, provide in an exhibit the following information requested in a-e. a) for the Applicant, submit the combined number of commercial communications service subscribers to wireless, wireline, broadband, and cable services that the Applicant serves and provide a list of the name(s) and the Federal Information Processing Standard (FIPS) number(s) for each county in which the Applicant has at least one commercial wireless, wireline, broadband, or cable subscriber; b) for each of the Applicant's Affiliates, Controlling Interests, and the Affiliates of its Controlling Interests, submit the individual or entity’s name, its FCC Registration Number (FRN), its relationship to the Applicant, and its combined number of commercial communications service subscribers to wireless, wireline, broadband, and cable services. For each of the Applicant's Affiliates, Controlling Interests, and the Affiliates of its Controlling Interests, also provide a list of the name(s) and the FIPS number(s) for each county in which it has at least one commercial wireless, wireline, broadband, or cable subscriber; c) if neither the Applicant, nor any of its Affiliates, its Controlling Interests, or the Affiliates of its Controlling Interests have at least one wireless, wireline, broadband, or cable subscriber in a market for which the Applicant is applying for a license, list the market(s) in which the Applicant, its Affiliates, its Controlling Interests, and the Affiliates of its Controlling Interests have no such subscribers; d) a detailed explanation demonstrating that: (i) the Applicant is in the business of providing commercial communications services; (ii) the Applicant serves predominantly rural areas; and (iii) the primary focus of the Applicant’s business activity is the provision of services to rural areas (defined as counties with a population density of 100 or fewer persons per square mile); and e) If the Applicant is an existing rural partnership that was providing service as of July 16, 2015, provide a detailed explanation demonstrating that each member of the partnership is independently eligible for the RSP bidding credit by providing, with respect to each member of the partnership, the same information as is required in a-d above. Subscriber counts should be current as of the date of filing this application. The Applicant, and other reporting entities, should count a subscriber only once even if that subscriber receives more than one service from the Applicant or entity. For example, a subscriber receiving both wireline service and broadband from the Applicant would be counted as a single subscriber of the Applicant.   FIPS numbers are available from the US Census Bureau and identified by the Commission as needed.

FCC Form 603	Schedule for Defined Geographic Areas To Be	Not Approved by OMB
Schedule B	Partitioned or for Spectrum To Be Disaggregated	3060-0800 See Main Form instructions for
		public burden estimate

1) Partitioner/Disaggregator Call Sign:

Partitioned Area

2) Defined Area To Be Partitioned	3) 0BUndefined Area To Be Partitioned (Complete Schedule C)	4) Population of Partitioned Area
	Schedule C # Attached:

5. Disaggregated Spectrum (in MHz)

1BDisaggregated Spectrum		2BDisaggregated Spectrum		Disaggregated Spectrum
Lower Frequency	Upper Frequency	Lower Frequency	Upper Frequency	Lower Frequency	Upper Frequency

5. Performance Requirements - Partitioning

(	)	Option 1	Partitioner and Partitionee each certify they will independently meet any service-specific performance requirements for their respective licensed areas.
(	)	Option 2	Partitioner and Partitionee each certify that they have agreed to share responsibility for meeting any service-specific performance requirements

7) Performance Requirements - Disaggregation

(	)	Option 1	Disaggregator and Disaggregatee each certify they will independently meet any service-specific performance requirements for their respective licensed areas.
(	)	Option 2	Disaggregator and Disaggregatee each certify that they have agreed to share responsibility for meeting any service-specific performance requirements.

8. Relocation of Incumbent Licensees

Does the proposed geographic partitioning, spectrum disaggregation, or a combination of both involve any incumbent relocation requirements? Yes/No

If ‘Y’, attach an exhibit with a certification regarding which party will meet these requirements, except as stated in service-specific rules.

FCC Form 603 Schedule for Undefined Areas To Be Partitioned Not Approved by OMB

Schedule C 3060 - 0800

Number:

See Main Form instructions for public burden estimate

For each undefined geographic area, complete up to 300 Latitude/Longitude combinations for every 3 degrees azimuth, using NAD83 Datum. Attach additional Schedule C’s if necessary.

Latitude (DD-MM-SS.S-D) Longitude (DDD-MM-SS.S-D)	Latitude (DD-MM-SS.S-D) Longitude (DDD-MM-SS.S-D)
1.	31.
2.	32.
3.	33.
4.	34.
5.	35.
6.	36.
7.	37.
8.	38.
9.	39.
10.	40.
11.	41.
12.	42.
13.	43.
14.	44.
15.	45.
16.	46.
17.	47.
18.	48.
19.	49.
20.	50.
21.	51.
22.	52.
23.	53.
24.	54.
25.	55.
26.	56.
27.	57.
28.	58.
29.	59.
30.	60.

FCC Form 603 Schedule for Undefined Areas To Be Partitioned

Schedule C

Number:

Latitude (DD-MM-SS.S-D) Longitude (DDD-MM-SS.S-D)	Latitude (DD-MM-SS.S-D) Longitude (DDD-MM-SS.S-D)
61.	91.
62.	92.
63.	93.
64.	94.
65.	95.
66.	96.
67.	97.
68.	98.
69.	99.
70.	100.
71.	101.
72.	102.
73.	103.
74.	104.
75.	105.
76.	106.
77.	107.
78.	108.
79.	109.
80.	110.
81.	111.
82.	112.
83.	113.
84.	114.
85.	115.
86.	116.
87.	117.
88.	118.
89.	119.
90.	120.

FCC Form 603	Schedule for Notification of Consummation of an
Schedule D	Assignment of Authorization or a Transfer of Control	3060 - 0800 See Main Form instructions
		for public burden estimate

1) Provide the File Number of the Assignment of Authorization or Transfer of Control application.	File Number:
2) Provide the actual date of consummation for the Assignment of Authorization or Transfer of Control.	(MM/DD/YYYY) / _/

FCC Form 603	Schedule for Request for Extension of Time To
Schedule E	Consummate an Assignment of Authorization or a Transfer of Control	3060 - 0800 See Main Form instructions
		for public burden estimate

1) Provide the File Number of the Assignment of Authorization or Transfer of Control application.	File Number:
2) Provide the consummation date for the Assignment of Authorization or Transfer of Control.	(MM/DD/YYYY) / _/

FCC Form 603 – Instructions

Edition Date - Page 2