Form FCC Form 703 FCC Form 703 Application for Consent to Transfer Control of Corporati

Approved by OMB

3060-0053

See reverse for public

burden estimate

UNITED STATES OF AMERICA

FEDERAL COMMUNICATIONS COMMISSION

PART I – APPLICATION FOR CONSENT TO TRANSFER CONTROL OF CORPORATION HOLDING STATION LICENSE

(This application must be filed before Transfer of Control takes place)

1. (a) Name of corporate licensee
(b) Number and street address of corporate licensee
(c) City			(d) State			(e) ZIP Code
(f) E-mail address of corporate licensee
2. Call sign and radio service of each station
3.(a) Fee Type Code EAE		(b) Fee Due $		(c) FCC Registration Number (FRN)
4. (a) Name of transferee
(b) To the attention of:
(c) Number and street address of transferee
(d) City	(e) State				(f) ZIP Code
(g) E-mail address of transferee
5. Subsequent to the Transfer of Control, will the licensee corporation be the same corporate entity? That is, will it retain its present name, Corporate charter, State of incorporation, etc.? If “NO” give details on Page 3.							Yes	No
6. Subsequent to the Transfer of Control, will the licensee corporation be a representative of any foreign government? If “YES”, give details on Page 3.
CERTIFICATION * Applicant waives any claim to the use of any particular frequency regardless of prior use by licensee or otherwise. * Applicant will have unlimited access to the radio equipment and will control access to exclude unauthorized persons. * Neither applicant nor any member thereof is a foreign government or representative thereof. * Applicant certifies that all statements made in this application and attachments are true, complete and made in good faith * Neither the applicant nor any other party to the applicant is subject to a denial of Federal benefits that includes FCC benefits pursuant to Section 5.301of the Anti-Drug Abuse Act of 1988, 21 U.S.C. Section 862. Because of a conviction for possession of distribution of a controlled substance.
WILLFUL FALSE STATEMENTS MADE ON THIS FORM ARE PUNISHABLE BY FINE AND/OR IMPRISONMENT (U.S. CODE, TITLE 18, SECTION 1001), AND/OR REVOCATION OF ANY STATION LICENSE OR CONSTRUCTION PERMIT (U.S. CODE, TITLE 47, SECTION 503).
SIGNATURE _____________________________________________________________________ DATE __________________________ Authorized Employee of Licensee Corporation SIGNATURE _____________________________________________________________________ DATE __________________________ Transferee of Control (Check One) Individual Partner Officer Other (Specify) : ____________________________________

Previous editions of this form are obsolete. FCC Form 703 – PAGE 1 2002 Edition

INSTRUCTIONS

This form applies only to stations authorized under Part 5 of the FCC Rules. This application must be filed where the only change is the transfer of control of the corporate licensee. If other changes are made or have been made, the appropriate application for modification of license should be filed.

1. Information entered for items 1 and 2 of Part I should be that of the current corporate licensee. If your answer differs from

that of the current corporate licensee, an explanation should be provided.

2. Enter an e-mail address (if applicable) in items 1f and 4g where the FCC can send you mail regarding your application.

3. Enter current fee in item 3b. Current fees may be obtained by referring to the Office of Engineering and Technology’s Fee Filing Guide at www.fcc.gov/fees/appfees.html or by requesting the “experimental license fees” at the FCC Consumer Information Bureau’s toll free number, 1-888-CALLFCC (1-888-225-5322).

4. Enter the FCC Registration Number (FRN) in Item 3c. If you do not have an FRN, apply for one using FCC Form 160 or at https://svartifoss2.fcc.gov/cores/CoresHome.html.

5. The information to be given in items 5 and 6 should be that information which will be true after the Transfer of Control has taken place.

6. The application must be signed and dated by an authorized employee of the licensee corporation and by the transferee of the control of the licensee corporation.

7. Complete items 1 and 2 of Part II. If item 1 differs from that of the current corporate licensee, an explanation should be

provided.

8. FCC Form 159 (Fee Remittance Advice) must be submitted with this application.

WHERE TO FILE

a. BY MAIL:

Federal Communications Commission

Experimental Radio Service

P. O. Box 979095

St. Louis, MO 63197-9000

* b. BY HAND-DELIVERY OR COURIER SERVICE:

Federal Communications Commission

US Bank,

Government Lockbox

1005 Convention Plaza

St. Louis, MO 63197-9000

* Applications hand delivered or sent by courier should be placed in an inner envelope with address “a” and then submitted

to address “b”.

NOTICE TO INDIVIDUALS REQUIRED BY PRIVACY ACT OF 1974 AND THE PAPER WORK REDUCTION ACT OF 1995

We have estimated that each response to this collection of information will take average of thirty-six minutes. Our estimate includes the time to read instructions, look through existing records, gather and maintain required data, and actually complete and review the form or response. If you have any comments on this estimate, or on how we can improve the collection and reduce the burden it causes you, please write the Federal Communications Commission, AMD-PERM , Washington, DC 20554. Paperwork Reduction Project (3060-0053). We will also accept your PRA comments via email if you send them to PRA@fcc,gov. DO NOT SEND COMPLETED APPLICATIONS TO THIS ADDRESS.

You are not required to respond to a collection of information sponsored by the Federal government and the government may not conduct or sponsor this collection unless it displays a currently valid OMB control number or if we fail to provide you with this notice. This collection has been assigned an OMB control number of 3060-0053.

The FCC is authorized under the Communications Act of 1934, as amended, to collect the personal information we request in this form. We will use the information you provide to determine whether approving this application is in the public interest. If we believe there may be a violation or potential violation of an FCC statute, regulation, rule or order, your application may be referred to the Federal, state, or local agency responsible for investigating, prosecuting, enforcing or implementing the statute, rule, regulation or order. In certain cases, the information in your application may be disclosed to the Department of Justice or a court or adjudicative body when (a) the FCC; or (b) any employee of the FCC; or (c) the United States Government, is a party to a proceeding before the body or has an interest in the proceedings.

This notice is required by the Privacy Act of 1974. Public Law 93-579, December 31, 1974, 5 U.S.C. Section 552a(e)(3) and the Paperwork Reduction Act of 1995 Public Law 104-13. October 1, 1995. 44 U.S.C. 3507.

FCC Form 703 – PAGE 2

2002 Edition

DETAILS / ADDITIONAL INFORMATION
UNITED STATES OF AMERICA FEDERAL COMMUNICATIONS COMMISSION PART II – AUTHORIZATION TO HOLD STATION LICENSE(S) AFTER TRANSFER OF CONTROL OF CORPORATION
1. Name and mailing address of corporate licensee	DO NOT WRITE IN THIS BLOCK CONDITIONS OF GRANT The corporate licensee is hereby authorized to continue holding the radio station license(s) listed in Item 2 on the basis of the representations made in the application for this authorization. This authorization is granted for the term of the outstanding license(s) for the station(s) listed in item 2. DATE AUTHORIZED: FEDERAL COMMUNICATIONS COMMISSION
2. Call sign and radio service of each station
THIS AUTHORIZATION TO BE FILED WITH CORPORATION’S RADIO STATION RECORDS

FCC Form 703 – PAGE 3

2002 Edition