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FCC 601 Worksheet

 
 
Applicant Information
Applicant Taxpayer Id #:
Must have this information to process the application
Applicant Name:
First: 
Last: 
MI: 
Person who will be signing the application
Title:
Company Name:
Mailing Address:
City:
State:
Zip:
Phone:
Fax:
E-mail Address:
 
Organization Type
Select
Describe the applicants
type of business:
  
   
Dealer Information
Contact Person:
Company:
Address:
City:
State:
Zip:
Phone:
Fax:
E-mail Address:
   
Licensing Data
Please describe your need for this application:
Will the new Frequencies be:
Is this a new System?
 
 
If No, what is your current call sign?
If we are modifying the License,
what are we doing?
Repeater & Mobiles:
Number of frequencies requested:
Total Number of Mobiles & Portables:     Output Power:     ERP:
Repeater or Base:

Output Power:        ERP:

Frequency Band (MHz)
If you are requesting specific frequencies please indicate here:
Is there a telephone Interconnect?
Portables and Mobile Applicants May Stop here.
   
Base & Repeater Transmitter Site Data
Station Address/Geographic Location:
City:
County:
State:
Latitude:
Longitude:
Datum used to plot coordinates:
Ground Elevation: Feet
Height of Structure: Feet
Overall Height to tip: Feet    (Antenna Height)
Structure Type:  
 If Other:
How is the antenna mounted to the structure, please describe:
Is this a new or existing site?
If existing, call sign of existing user on this site:
Tower owners name:
Telephone #:
Antenna Structure Registration
Do you know of an existing FAA Notification on the site?
If yes #
   
 
 
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