Fcc Form 605 - Quick-Form Application For Authorization In The Ship, Aircraft, Amateur, Restricted And Commercial Operator, And General Mobile Radio Services Page 21
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25FCC 605
Schedule for Additional Data in the
Approved by OMB
Amateur Radio Service
Schedule D
3060 - 0850
See 605 Main Form Instructions
for public burden estimate
AMATEUR STATION CALL SIGN CHANGE AND VANITY CALL SIGN REQUEST
Systematic Call Sign Change
1) Is this a request to change a station call sign systematically?
(
)
Yes No
If you answered Yes (‘Y’) to Item 1, do not complete Items 2 and 3 on this schedule. If completing Item 2, Item 1 must be answered No (‘N’).
Vanity Call Sign Change
2) I hereby apply for a vanity call sign under the following eligibility: (make an ‘X’ in the appropriate box and enter the required information):
(Only 1 block may be checked)
)
FORMER PRIMARY STATION HOLDER: I request call sign _______________ be shown on my primary station license. This call
A
sign was previously shown on my primary station license.
B)
CLOSE RELATIVE OF FORMER HOLDER: I request call sign _______________ be shown on my primary station license. This call
sign was previously shown on the primary station license of my deceased spouse, child, grandchild, stepchild, parent, grandparent,
stepparent, brother, sister, stepbrother, stepsister, aunt, uncle, niece, nephew, or in-law. Enter the deceased relationship to you:
_____________________________________________________.
C)
FORMER CLUB STATION HOLDER: I request call sign _______________ be shown on the license for the club station, for which I
am the license trustee. This call sign was previously shown on the license for this club station.
D)
CLUB STATION WITH CONSENT OF C LOSE RELATIVE OF FORMER HOLDER: I request call sign _______________ be shown on
the license for the club station, for which I am the license trustee. This call sign was previously shown on the primary station license of
a person now deceased. I am acting with written consent of the deceased person’s spouse, child, grandchild, stepchild, parent,
grandparent, stepparent, brother, sister, stepbrother, stepsister, aunt, uncle, niece, nephew, or in-law. Enter the deceased
relationship to the person giving consent ____________________________________________.
E)
PRIMARY STATION PREFERENCE LIST: I request the first assignable call sign from my preference list in item #3 be shown on the
license for my primary station.
F)
CLUB STATION PREFERENCE LIST: I request the first assignable call sign from my preference list in item #3 be shown on the
license for the club station, for which I am the license trustee.
Vanity Call Sign PREFERENCE LIST
.
3) Select your preference list of vanity call signs very carefully. Give exact prefix, numeral, and suffix for each call sign
1)
6)
11)
16)
21)
2)
7)
12)
17)
22)
3)
8)
13)
18)
23)
4)
9)
14)
19)
24)
5)
10)
15)
20)
25)
Note: If none of the call signs you selected are assignable, you will retain your existing call sign.
FCC 605 - Schedule D
July 2002 - Page 1
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