Application To Participate In An Fcc Auction Fcc 175 (Page 4 of 4) in pdf

Instructions

Item 1. Applicant Name: Enter the legal name of the person or entity applying to

Item 13. Exhibits. If exhibits are attached to the application, check the box

provided and indicate the number of exhibits. List in an exhibit the name,

participate in an auction. If other than an individual, insert the exact name of the

entity as it appears on the legal document(s) establishing the entity, such as the

citizenship and address of all partners, if the applicant is a partnership; of a responsible

Articles of Incorporation.

officer or director, if the applicant is a corporation; of the trustee, if the applicant is a

[NOTE: Applicants who have entered into an arrangement(s) of any kind

trust; or if the applicant is none of the foregoing, list the name, address and citizenship

relating to the license(s) and/or construction permit(s) specified in this

of a principal or other responsible person. See 47 C.F.R. § 1.2105(a). In addition, list

application must provide additional information.

See Exhibit instructions

in an exhibit the specific ownership information as set forth in 47 C.F.R. § 1.2112.

below.]

Also list in an exhibit all parties with whom the applicant has entered into an

agreement(s), of any kind, relating to the facilities being auctioned including, where

Item 2. Applicant Mailing Address: Enter the street address (no Post Office Boxes)

applicable, such agreement(s) relating to the post-auction market structure. See 47

C.F.R. § 1.2105(a). For broadcast applicants, the anti-collusion provisions of 47

suitable for mail or private parcel delivery, for the applicant

C.F.R. Part 1 are modified pursuant to 47 C.F.R. § 73.5002(d).

Item 3. City: Enter the city name for the applicant mailing address.

Item 14. Authorized Bidders: Enter the name(s) of the person(s) you wish to

Item 4. State: Enter the two-letter state abbreviation.

designate as an authorized representative(s). Only authorized representatives will be

allowed to make or withdraw bids at an auction. You may list a maximum of three (3)

Item 5. ZIP Code: Enter the Zip Code for the applicant address.

authorized representatives.

Item 6. Auction Number: Enter the appropriate auction number supplied by the

Item 15. Certification: Enter the name of the individual authorized to submit the

Commission in the Public Notice.

application, his/her title, date of submission.

Item 16. Contact person/address: Enter the name of a person familiar with the

Item 7.

Taxpayer Identification Number: Enter your nine-digit Taxpayer

application (contact person) and the address, phone number, fax number (including

Identification Number (TIN). The Taxpayer Identification Number is your Employer

area code), and e-mail address of the contact person.

All written and verbal

Identification Number (EIN) or your Social Security Number (SSN), as reported to the

communications and registration information will be directed to the applicant’s

Internal Revenue Service (IRS).

contact person at the address/phone number specified on the FCC Form 175.

Item 8. Applicant Classification: Place an [X] in the appropriate box preceding the

NOTE: The Commission's Public Notice announcing the auction of the facilities for

type of legal entity applying. Limited Liability Companies should check the "LLC"

which you are interested in bidding, and related documents, contain information

box. Unincorporated Associations should check the "Association" box. Governmental

essential to completing this form correctly. You should also consult the specific rules

Entities should check the "Gov't Entity" box. All partnerships should check the

governing the service in which you are applying.

Forms which are completed

"Partnership" box and indicate in an exhibit whether they are a general or limited

incorrectly may be dismissed without an opportunity for resubmission.

partnership.

Item 9. Applicant Status: Place an [X] in the appropriate box or boxes preceding the

Schedule A - Wireless Facilities: Enter the code for the market(s) on which you want

type of entity. The definition of "noncommercial educational" entity applies to

to bid in the column under Market No.

The codes will be provided by the

Commission in a Public Notice. Use a separate line for each different market. If you

broadcast applicants only and is contained in 47 U.S.C. 397(6) and 47 C.F.R. §

want to be eligible to bid on licenses in all markets, you should place an [X] in the box

73.503(a) (for radio) and 47 C.F.R. § 73.621(a) (for television). The definitions for

marked "ALL." After each market, list the letter(s) or number(s) for the frequency

"rural telephone company", "minority owned business", and "woman owned business"

block(s) or channel(s) on which you intend to bid. These codes will be provided by

are contained in 47 C.F.R. § 1.2110. Applicant status information concerning rural

the Commission in a Public Notice. For example, if you want to bid on two frequency

telephone companies, minority-owned businesses and women-owned businesses is

blocks in market (a) and one block in market (b), to be eligible you would enter the

collected for statistical purposes only.

codes for the two desired frequency block(s) in market (a) in columns 1 and 2 on line

Item 10. Bidding Credit Eligibility: If bidding in a wireless auction, place an [X] in

(a) and leave the remaining columns on that line blank. On line (b) you would enter in

column 1 the code for the frequency block you want in market (b) and leave the

the box preceding the Small Business or Very Small Business designated entity type, if

remaining columns on the line blank. If you want to be eligible to bid on all frequency

appropriate. This information will be used for determining the applicant's eligibility

blocks in all available markets, you should place an [X] in the box marked "ALL".

for special provisions available for wireless designated entities. For definitions of the

types of designated entities, see the Commission's Rules at 47 C.F.R. Part 1, Subpart Q

Schedule B - Broadcast Facilities: Enter the name of the service for the facility on

and the specific Commission Rules governing the wireless service for which you are

applying. If bidding in a broadcast auction, place an [X] in the box preceding the New

which you intend to bid using the following code designators: AM Radio - AM; FM

Entrant designated entity type, if appropriate. This information will be used for

Radio - FM; Full Power Television - PST; FM Translator - FMT; TV Translator and

determining the applicant's eligibility for the New Entrant bidding credit available for

Low Power Television SST. Use a separate line for each different facility. Indicate

designated entities. See 47 C.F.R. §§ 73.5007 & 73.5008. All designated entities

whether the facility for which you want to bid is a new facility or a "major

modification" to an existing facility, as defined in 47 C.F.R. § 73.3571(a)(1) (AM

must specify which percent bidding credit applies. Applicants ineligible for a bidding

Radio), § 73.3572(a)(1) (Full Power Television, Low Power Television and Television

credit should leave the question blank. In addition, applicants claiming eligibility for

Translators), § 73.3573(a)(1) (FM Radio), and § 74.1233(a)(1) (FM Translators). If

the Small Business or Very Small Business bidding credit, must set forth, in an

you intend to bid on an AM Radio facility, enter the Frequency of that facility;

exhibit, the applicant's gross revenues, and its affiliates' gross revenues, in accordance

otherwise enter the Channel number. Enter the Community of License (both City and

with the Commission's Rules governing the auctionable service. Applicants claiming

State) of the facility for which you intend to bid. Enter the File Number of the

eligibility for the New Entrant bidding credit must list, in an exhibit, the applicant's

other media of mass communications in accordance with 47 C.F.R. §§ 73.5007 &

pertinent broadcast application (i.e., FCC Form 301 for AM, FM and television

73.5008.

stations; FCC Form 346 for LPTV and television translators, or FCC Form 349 for FM

Translators) you have filed for the facility on which you intend to bid, if applicable.

Item 11. Entrepreneur Eligibility. If bidding in a wireless auction, place an [X] in

the box preceding the Entrepreneur Eligibility, if appropriate. This will signify that the

applicant is qualified to bid in an entrepreneur block auction. For the rules concerning

eligibility, see 47 C.F.R. 24.709.

October 2000

Item 12. Facilities for which you want to bid. If bidding for wireless licenses, use

Schedule A. If bidding for broadcast construction permits, use Schedule B. In

addition, see the specific instructions for Schedules A and B.

Application To Participate In An Fcc Auction Fcc 175 Page 4

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