Form 159 - Remittance Advice - Federal Communications Commission Page 2

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Approved by OMB
3060-0589
FEDERAL COMMUNICATIONS COMMISSION
SPECIAL USE
REMITTANCE ADVICE (CONTINATION SHEET)
FORM 159-C
FCC USE ONLY
2
2
Page No__ of__
USE THIS SECTION ONLY FOR EACH ADDITIONAL APPLICANT
SECTION BB – ADDITIONAL APPLICANT INFORMATION
(13) APPLICANT NAME
(14) STREET ADDRESS LINE NO.1
(15) STREET ADDRESS LINE NO. 2
(16) CITY
(17) STATE
(18) ZIP CODE
(19) DAYTIME TELEPHONE NUMBER (include area code)
(20) COUNTRY CODE (if not in U.S.A.)
FCC REGISTRATION NUMBER (FRN) REQUIRED
(21) APPLICANT (FRN)
(22) FCC USE ONLY
COMPLETE SECTION C FOR EACH SERVICE, IF MORE BOXES ARE NEEDED, USE CONTINUATION SHEET
(23A) CALL SIGN/OTHER ID
(24A) PAYMENT TYPE CODE
(25A) QUANTITY
(26A) FEE DUE FOR (PTC)
(27A) TOTAL FEE
FCC USE ONLY
(28A) FCC CODE I
(29A) FCC CODE 2
(23B) CALL SIGN/OTHER ID
(24B) PAYMENT TYPE CODE
(25B) QUANTITY
(26B) FEE DUE FOR (PTC)
(27B) TOTAL FEE
FC C USE ONLY
(28B)FCC CODE I
(29B) FCC CODE 2
(23C) CALL SIGN/OTHER ID
(24C) PAYMENT TYPE CODE
(25C) QUANTITY
(26C) FEE DUE FOR (PTC)
(27C) TOTAL FEE
FCC USE ONLY
(28C) FCC CODE I
(29C) FCC CODE 2
(23D) CALL SIGN/OTHER ID
(24D) PAYMENT TYPE CODE
(25D) QUANTITY
(26D) FEE DUE FOR (PTC)
(27D) TOTAL FEE
FC C USE ONLY
(28D)FCC CODE I
(29D) FCC CODE 2
(23E) CALL SIGN/OTHER ID
(24E) PAYMENT TYPE CODE
(25E) QUANTITY
(26E) FEE DUE FOR (PTC)
(27E) TOTAL FEE
FCC USE ONLY
(28E) FCC CODE I
(29E) FCC CODE 2
(23F) CALL SIGN/OTHER ID
(24F) PAYMENT TYPE CODE
(25F) QUANTITY
(26F) FEE DUE FOR (PTC)
(27F) TOTAL FEE
FC C USE ONLY
(28F)FCC CODE I
(29F) FCC CODE 2
SEE PUBLIC BURDEN ON REVERSE
FCC FORM 159-C
FEBRUARY 2003

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