1. |
Party Filing Pleading or Appeal
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Mailing Address
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City
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State or Country (if foreign address)
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Zip Code
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Telephone Number (include area code)
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E-Mail Address (if available)
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2. |
Contact Representative
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Firm or Company Name
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Mailing Address
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City
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State or Country (if foreign address)
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ZIP Code
- |
Telephone Number (include area code)
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E-Mail Address (if available)
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3. |
Purpose:
Informal Objection |
Petition to Deny |
Petition for Reconsideration |
Application for Review |
Opposition |
Reply |
Supplement |
4. |
[Enter File Number]
| Pleading Filed Date : |
Pleading Filer Name: |
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5. |
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[Exhibit 1] |
I hereby certify that the statements in this application are true, complete, and correct to the best of my knowledge and belief, and are made in good faith. I acknowledge that all certifications and attached Exhibits are considered material representations.
Typed or Printed Name of Person Signing
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Typed or Printed Title of Person Signing
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Signature
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Date
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WILLFUL FALSE STATEMENTS 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 312(a)(1)), AND/OR FORFEITURE (U.S. CODE, TITLE 47, SECTION 503).