Section I
Does your station employment unit employ
fewer than five full-time employees, if television, or
fewer than eleven full-time employees, if radio?
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Yes
No
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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
instructions.
CERTIFICATION
This report must be certified, as follows:
A. By licensee, if an individual;
B. By a partner, if a partnership (general partner, if a
limited partnership);
C. By an officer, if a corporation or an association; or
D. By an attorney of the licensee, in case of physical
disability or absence from the United States of the
licensee.
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).
I certify to the best of my knowledge,
information and belief, all statements contained in this report
are true and correct.
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