Form Fcc 383 Draft - Digital Channel Election For Television Broadcast Station: First Round Conflict Decision Page 6
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11DRAFT
Federal Communications Commission
Not Approved by OMB
Washington, D. C. 20554
FOR
FCC
USE
FCC 383
ONLY
DIGITAL CHANNEL ELECTION FORM
FOR COMMISSION USE ONLY
FIRST ROUND CONFLICT DECISION
FILE NO.
Must Be Filed by ______[DATE]__________
PLEASE READ INSTRUCTIONS BEFORE
COMPLETING THIS FORM
SECTION I - GENERAL INFORMATION
Licensee/Permittee Information
1.
Legal Name of the Licensee/Permittee
Mailing Address
State or Country (if foreign address)
City
ZIP Code
Telephone Number (include area code)
E-Mail Address (if available)
Station/Facility Information
2.
FCC Registration Number
Call Sign
Facility ID Number
Community of License: City
State
Currently Assigned Channels:
3.
DTV Channel
a.
Not Applicable
NTSC Channel
b.
Not Applicable
Contact Information (if different from licensee/permittee)
4.
Contact Representative
Firm or Company Name
Mailing Address
City
State or Country (if foreign address)
ZIP Code
Telephone Number (include area code)
E-Mail Address (if available)
Purpose of Form:
The purpose of the First Round Conflict Decision Form is for first round electors that were notified by the Commission that
5.
their channel election results in an interference conflict to make a decision concerning resolution of their interference
conflict. (SELECT ONE)
FCC Form 383
a.
Conflict Decision
b.
Amendment
(date)
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