Supplemental Information 72-76 MHz Operational Fixed Stations {1068A}

FCC 1068A FEDERAL COMMUNICATIONS COMMISSION Approved by OMB 3060 -0132 Information and Instructions Est. Avg. Burden Per Response: 30 Minutes SUPPLEMENTAL INFORMATION 72-76 MHz OPERATIONAL FIXED STATIONS 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 30 minutes. 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 Proj ect (3060-0132). We will also accept your comments via the Internet if you send them to Judith-B.Herman@fcc.gov. 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 3060-0132. 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. As of December 3, 2001, all parties and entities doing busine ss 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 through the FCC webpage at http://www.fcc.gov or by manually submitting FCC Form 160. FCC Form 160 is available from the FCCs web site at http://www.fcc.gov/formpage.html, by calling the FCCs Forms Distribution Center 800-418-FORM (3676), or from Right Fax by dialing (202) 418-0177. 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. FCC 1068A - Instructions March 2004 - Page 1 American LegalNet, Inc. www.USCourtForms.com<<<<<<<<<********>>>>>>>>>>>>> 2 INSTRUCTIONS FOR FCC 1068A NOTE: This form must be submitted along with your FCC 601 submission (can be submitted as an attachment if filing electronically). Item 1: Enter the location of your proposed station. All coordinates must be referenced to the North American Datum of 1983 (NAD83). This information can be determined in many ways, including a GPS receiver, a 7.5-minute topographical quadrangle map of the area, or you may consult the city or county/borough/parish surveyor in your area. Topographical maps may be purchased from the U.S. Geological Survey, Washington, DC 20242 or from its office in Denver, Colorado 80225. Enter the latitude using the format DD-MM-SS , where the degrees (DD) term can have a value in the range of 0 to 71, minutes (MM) can range from 0 to 59, and seconds (SS ) can range from 0 to 59.9. If desired, seconds may be rounded to the nearest tenth of a second (in which case, use the format DD-MM-SS.S). In the right corner, specify the direction as either N for North or S for South. Enter the longitude using the format DDD-MM-SS , where the degrees (DDD) term can have a value in the range of 64 to 180, minutes (MM) can range from 0 to 59, and seconds (SS ) can range from 0 to 59.9. If desired, seconds may be rounded to the nearest tenth of a second (in which case, use the format DDD-MM-SS.S). In the right corner, specify the direction as either E for East or W for West. Enter the City, Town or Village within the stations County/Borough/Parish is nearby, and enter the County/Borough/Parish and State in which the coordinates are actually located. Refer to FCC 601 Main Form Instructions, Appendix II, for a list of valid state, jurisdiction, and area codes. Item 2: Enter the City and State of the location of nearest TV Channel 4 transmitter. Visit http://www.fcc.gov/mb/video/tvq.html to determine if the proposed station is within 128 km of a Channel 4 transmitter or review Appendix I for the distance. Item 3: Enter the City and State of the location of nearest TV Channel 5 transmitter. Visit http://www.fcc.gov/mb/video/tvq.html to determine if the proposed station is within 128 km of a Channel 5 transmitter or review Appendix II for the distance. Item 4: Complete if proposed station is within 128 km (80 miles) airline distance from a Channel 4 transmitter. Item 5: Complete if proposed station is within 128 km (80 miles) airline distance from a Channel 5 transmitter. Item 6: By signing this form, the applicant certifies that the statements listed in this section are true, complete, correct, and made in good faith. Item 7: This item 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 applicant typed on the application as a signature. Enter your 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 thro