station employment unit employ fewer than five full-time employees,
if television, or fewer than eleven full-time employees, if radio?
If yes, you do not have to file this form
with the FCC. However, you have the option to complete the certification
below, return the form to the FCC, and place a copy in your station(s)
public file. You do not have to complete the rest of this form. If your
station employment unit employs five or more full-time employees, if
television, or eleven or more full-time employees, if radio, you must
complete all of this form and follow all
This report must be certified, as
A. By licensee, if an individual;
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
B. By a
partner, if a partnership (general partner, if a limited
C. By an officer, if a corporation or an association;
D. By an attorney of the licensee, in case of physical disability or
absence from the United States of the licensee.
I certify to the best
of my knowledge, information and belief, all statements contained in this
report are true and correct.