Fcc Form 605 - Quick-Form Application For Authorization In The Ship, Aircraft, Amateur, Restricted And Commercial Operator, And General Mobile Radio Services Page 10
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25Quick-Form Application for Authorization in the Ship, Aircraft,
FCC 605
Approved by OMB
Amateur, Restricted and Commercial Operator,
Main Form
3060 - 0850
and General Mobile Radio Services
See instructions for
public burden estimate
1) Radio Service Code:
Application Purpose (Select only one) (
)
2) NE – New
RO – Renewal Only
WD – Withdrawal of Application
MD – Modification
RM – Renewal / Modification
DU – Duplicate License
AM – Amendment
CA – Cancellation of License
AU – Administrative Update
3)
If this request if for Developmental License or STA (Special Temporary Authorization) enter the
(
) D S N/A
appropriate code and attach the required exhibit as described in the instructions. Otherwise enter ‘N’
(Not Applicable).
4)
If this request is for an Amendment or Withdrawal of Application, enter the file number of the pending
File Number
application currently on file with the FCC.
5)
If this request is for a Modification, Renewal Only, Renewal / Modification, Cancellation of License,
Call Sign/Serial #
Duplicate License, or Administrative Update, enter the call sign (serial number for Commercial
Operator) of the existing FCC license. If this is a request for consolidation of DO & DM Operator
Licenses, enter serial number of DO.
6)
If this request is for a New, Amendment, Renewal Only, or Renewal Modification, enter the
MM
DD
requested
expiration date of the authorization (this item is optional).
7)
Does this filing request a Waiver of the Commission’s rules? If ‘Y’, attach the
(
) Yes
No
required showing as described in the instructions.
8)
Are attachments (other than associated schedules) being filed with this application?
(
) Yes No
Applicant Information
9) FCC Registration Number (FRN):
10) Applicant /Licensee is a(n):
(
) Individual
Unicorporated Association
Trust
Government Entity
Joint Venture
Corporation
Limited Liability Corporation
Partnership
Consortium
11) First Name (if individual):
MI:
Last Name:
Suffix:
11a) Date of Birth (required for Commercial Operators (including Restricted Radiotelephone)): _____(mm)/_____(dd)/_____(yy)
12) Entity Name (if other than individual):
13) Attention To:
14) P.O. Box:
And/Or
15) Street Address:
16) City:
17) State:
18) Zip Code:
19) Country:
20) Telephone Number:
21) FAX Number:
22) E-Mail Address:
FCC 605 – Main Form
July 2002 - Page 1
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