Approved by OMB (June 2002)

Size: px
Start display at page:

Download "Approved by OMB (June 2002)"

Transcription

1 1 of 8 8/3/2015 8:12 AM Federal Communications Commission Washington, D.C FCC 323-E Approved by OMB (June 2002) Ownership Report For Noncommercial Educational Broadcast Station FOR FCC USE ONLY FOR COMMISSION USE ONLY FILE NO. BOA AQX Read INSTRUCTIONS Before Filling Out Form Section I - General 1. Legal Name of the Licensee/Permittee SOUTHERN CALIFORNIA PUBLIC RADIO Mailing Address 480 CEDAR STREET City ST. PAUL Telephone Number (include area code) FCC Registration Number: Call Sign KVLA-FM 2. Contact Representative (if other than Licensee/Permittee) MELODIE VIRTUE Mailing Address 1000 POTOMAC STREET NW 5TH FLOOR, FLOUR MILL BUILDING City WASHINGTON Telephone Number (include area code) Name of entity, if other than licensee or permittee, for which report is filed State or Country (if foreign address) MN Address (if available) FCCFILING@MPR.ORG Facility ID Number Firm or Company Name GARVEY SCHUBERT BARER State or Country (if foreign address) DC Address (if available) MVIRTUE@GSBLAW.COM ZIP Code ZIP Code Mailing Address City State or Country (if foreign address) ZIP Code - Telephone Number (include area code) Address (if available) Section II - Ownership Information 4. All of the information furnished in this Report is accurate as of 7/31/2015 (Date must comply with 47 C.F.R. Section (d), i.e., information must be current within 60 days of filing of this report, when 4(a) below is checked.) This Report is filed for (check one) a. Biennial b. Transfer of Control or Assignment of License/Permit c. Other d. Amendment to pending application for the following stations: [Enter Station Information] Station List This Report is filed for the following stations:

2 2 of 8 8/3/2015 8:12 AM Call Letters Facility ID Number Location (City/State) Class of service KVLA-FM COACHELLA CA FM Call Letters Facility ID Number Location (City/State) Class of service KJAI OJAI CA FM 5. List all contracts and other instruments required to be filed by 47 C.F.R. Section (Only licensees, permittees, or a reporting entity with a majority interest in or that otherwise exercises de facto control over the subject licensee or permittee shall respond.) [Enter Contract/Instrument Information] Contracts/Instruments Information List all contracts and other instruments required to be filed by 47 C.F.R. Section (Only licensees, permittees, or a reporting entity with a majority interest in or that otherwise exercises de facto control over the subject shall respond.) Description of Contract or Instrument Name of person or organization with whom contract is made Date of Execution (mm/dd /yyyy) Date of Expiration (mm/dd/yyyy) SCPR RESTATED BYLAWS ON FILE JULY 25, Is the governing board directly or indirectly under the control of another entity? Yes No If Yes, is a separate FCC Form 323-E submitted for such entity? Yes No 7. List officers, members of governing board, and holders of 1% or more ownership interest, if any. Use one column for each individual or entity. Attach supplemental pages, if necessary. [Enter Owner Information] Owner Information List officers, members of governing board, and holders of 1% or more ownership interest, if any. Use one column for each individual or entity. Attach supplemental pages if necessary. (Read carefully - The numbered items below refer to line numbers in the following table.) a. Name and address of officer, member of governing board, and holders of 1% or more ownership interest (if other than individual also show name, address and citizenship of natural person authorized to vote the interest). List officers first, then board members, and thereafter, holders of 1% or more ownership interest, if any. b. Citizenship. c. Office held. d. Percent of interest held. e. Principal profession or f. By whom appointed or elected. g. Existing interests in any other broadcast station, including the nature and size of such interests. a. Name and Address. ROBERT ADLER, SCPR, 474 SOUTH RAYMOND AVENUE, PASADENA, CA & TREASURER e. Principal profession or CORPORATE ADMIN a. Name and Address. THOMAS CASTRO, SCPR, 474 SOUTH RAYMOND AVENUE, PASADENA, CA

3 3 of 8 8/3/2015 8:12 AM a. Name and Address. GORDON CRAWFORD, SCPR, 474 SOUTH RAYMOND AVENUE, PASADENA, CA c. Office held. LIFE TRUSTEE e. Principal profession or RETIRED a. Name and Address. THOMAS WILLIAM DAVIS, SCPR, 474 SOUTH RAYMOND AVENUE, PASADENA, CA & SCPR PRESIDENT g. Existing interests TRUSTEE & PRESIDENT OF LICENSEE a. Name and Address. HILARY GARLAND, SCPR, 474 SOUTH RAYMOND AVENUE, PASADENA, CA e. Principal profession or PSYCHOLOGY a. Name and Address. JAMES GIANOPULOS, SCPR, 474 SOUTH RAYMOND AVENUE, PASADENA, CA a. Name and Address. FERNANDO GUERRA, SCPR, 474 SOUTH RAYMOND AVENUE, PASADENA, CA

4 4 of 8 8/3/2015 8:12 AM & CHAIR e. Principal profession or EDUCATION a. Name and Address. DAVID HILL, SCPR, 474 SOUTH RAYMOND AVENUE, PASADENA, CA a. Name and Address. JIHEE KIM HUH, SCPR, 474 SOUTH RAYMOND AVENUE, PASADENA, CA c. Office held. LIFE TRUSTEE a. Name and Address. GARY KISHNER, SCPR, 474 SOUTH RAYMOND AVENUE, PASADENA, CA a. Name and Address. DARCY KOPCHO, SCPR, 474 SOUTH RAYMOND AVENUE, PASADENA, CA a. Name and Address. C DOUGLAS KRANWINKLE, SCPR, 474 SOUTH RAYMOND AVENUE, PASADENA, CA

5 5 of 8 8/3/2015 8:12 AM & SECRETARY e. Principal profession or RETIRED a. Name and Address. STEPHEN MCDONALD, SCPR, 474 SOUTH RAYMOND AVENUE, PASADENA, CA a. Name and Address. JON MCTAGGART, SCPR, 474 SOUTH RAYMOND AVENUE, PASADENA, CA g. Existing interests PRESIDENT & CEO APMG, LICENSEE OF WCKP MIAMI FL, & MINNESOTA PUBLIC RADIO, LICENSEE OF NUMEROUS PUBLIC RADIO STATIONS, SEE EXHIBIT FILED WITH OWNERSHIP REPORT BOA AVU, TRUSTEE & STAFF OFFICER OF CLASSICAL SOUTH FLORIDA, LICENSEE OF WPBI & WNPS. a. Name and Address. MOLLY MUNGER, SCPR, 474 SOUTH RAYMOND AVENUE, PASADENA, CA a. Name and Address. JAMES PICK, SCPR, 474 SOUTH RAYMOND AVENUE, PASADENA, CA e. Principal profession or EDUCATION

6 6 of 8 8/3/2015 8:12 AM a. Name and Address. JULLIAN POON, SCPR, 474 SOUTH RAYMOND AVENUE, PASADENA, CA e. Principal profession or LAW a. Name and Address. VIRGIL ROBERTS, SCPR, 474 SOUTH RAYMOND AVENUE, PASADENA, CA c. Office held. LIFE TRUSTEE e. Principal profession or LAW a. Name and Address. ANA VALDEZ, SCPR, 474 SOUTH RAYMOND AVENUE, PASADENA, CA & FIRST VICE CHAIR g. Existing interests TRUSTEE OF MINNESOTA PUBLIC RADIO, LICENSEE OF NUMEROUS PUBLIC RADIO STATIONS, SEE EHIBIT FILED WITH OWNERSHIP REPORT BOA AVU. a. Name and Address. HAROLD WILLIAMS, SCPR, 474 SOUTH RAYMOND AVENUE, PASADENA, CA c. Office held. LIFE TRUSTEE e. Principal profession or RETIRED a. Name and Address. CHARLES WOO, SCPR, 474 SOUTH RAYMOND AVENUE, PASADENA, CA

7 7 of 8 8/3/2015 8:12 AM a. Name and Address. MORRIS GOODWIN, SCPR, 474 SOUTH RAYMOND AVENUE, PASADENA, CA c. Office held. STAFF OFFICER f. By whom appointed or elected. PRESIDENT g. Existing interests STAFF OFFICER APMG, LICENSEE OF WCKP MIAMI FL & MPR, LICENSEE OF NUMEROUS PUBLIC RADIO STATIONS, SEE EXHIBIT FILED WITH OWNERSHIP REPORT BOA AVU, TRUSTEE & STAFF OFFICER OF CLASSICAL SOUTH FLORIDA, LICENSEE OF WPBI & WNPS. a. Name and Address. DAVID KANSAS, SCPR, 474 SOUTH RAYMOND AVENUE, PASADENA, CA c. Office held. STAFF OFFICER f. By whom appointed or elected. PRESIDENT g. Existing interests STAFF OFFICER, APMG, LICENSEE OF WCKP MIAMI FL & MPR, LICENSEE OF NUMEROUS PUBLIC RADIO STATIONS, SEE EXHIBIT FILED WITH OWNERSHIP REPORT BOA AVU, TRUSTEE & STAFF OFFICER OF CLASSICAL SOUTH FLORIDA, LICENSEE OF WPBI & WNPS. a. Name and Address. SYLVIA STROBEL, SCPR, 474 SOUTH RAYMOND AVENUE, PASADENA, CA c. Office held. STAFF OFFICER f. By whom appointed or elected. PRESIDENT g. Existing interests STAFF OFFICER, APMG, LICENSEE OF WCKP MIAMI FL & MPR, LICENSEE OF NUMEROUS PUBLIC RADIO STATIONS, SEE EXHIBIT FILED WITH OWNERSHIP REPORT BOA AVU, TRUSTEE & STAFF OFFICER OF CLASSICAL SOUTH FLORIDA, LICENSEE OF WPBI & WNPS. SECTION III - CERTIFICATION I certify that I am PRESIDENT (Official Title) of SOUTHERN CALIFORNIA PUBLIC RADIO

8 8 of 8 8/3/2015 8:12 AM (Exact legal title or name of respondent) and that I have examined this Report and that to the best of my knowledge and belief, all statements in this Report are true, correct and complete. (Date of certification must be within 60 days of the date shown in Question 4, Section II and in no event prior to that date.) Signature THOMAS WILLIAM DAVIS Telephone Number of Respondent (Include area code) Date 7/31/2015 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). Exhibits

9 1 of 6 8/3/2015 8:13 AM Federal Communications Commission Washington, D.C FCC 323-E Approved by OMB (June 2002) Ownership Report For Noncommercial Educational Broadcast Station FOR FCC USE ONLY FOR COMMISSION USE ONLY FILE NO. BOA AQZ Read INSTRUCTIONS Before Filling Out Form Section I - General 1. Legal Name of the Licensee/Permittee SOUTHERN CALIFORNIA PUBLIC RADIO Mailing Address 480 CEDAR STREET City ST. PAUL Telephone Number (include area code) FCC Registration Number: Call Sign KVLA-FM 2. Contact Representative (if other than Licensee/Permittee) MELODIE VIRTUE Mailing Address 1000 POTOMAC STREET NW 5TH FLOOR, FLOUR MILL BUILDING City WASHINGTON Telephone Number (include area code) Name of entity, if other than licensee or permittee, for which report is filed AMERICAN PUBLIC MEDIA GROUP Mailing Address 480 CEDAR STREET State or Country (if foreign address) MN Address (if available) FCCFILING@MPR.ORG Facility ID Number Firm or Company Name GARVEY SCHUBERT BARER State or Country (if foreign address) DC Address (if available) MVIRTUE@GSBLAW.COM ZIP Code ZIP Code City SAINT PAUL Telephone Number (include area code) State or Country (if foreign address) MN Address (if available) FCCFILING@MPR.ORG ZIP Code Section II - Ownership Information 4. All of the information furnished in this Report is accurate as of 7/31/2015 (Date must comply with 47 C.F.R. Section (d), i.e., information must be current within 60 days of filing of this report, when 4(a) below is checked.) This Report is filed for (check one) a. Biennial b. Transfer of Control or Assignment of License/Permit c. Other d. Amendment to pending application for the following stations: [Enter Station Information] Station List

10 This Report is filed for the following stations: Call Letters Facility ID Number Location (City/State) Class of service KVLA-FM COACHELLA CA FM Call Letters Facility ID Number Location (City/State) Class of service KJAI OJAI CA FM 5. List all contracts and other instruments required to be filed by 47 C.F.R. Section (Only licensees, permittees, or a reporting entity with a majority interest in or that otherwise exercises de facto control over the subject licensee or permittee shall respond.) [Enter Contract/Instrument Information] Contracts/Instruments Information List all contracts and other instruments required to be filed by 47 C.F.R. Section (Only licensees, permittees, or a reporting entity with a majority interest in or that otherwise exercises de facto control over the subject shall respond.) Description of Contract or Instrument Name of person or organization with whom contract is made Date of Execution (mm/dd /yyyy) Date of Expiration (mm/dd/yyyy) APMG RESTATED BYLAWS ON FILE NOVEMBER 14, Is the governing board directly or indirectly under the control of another entity? Yes No If Yes, is a separate FCC Form 323-E submitted for such entity? Yes No 7. List officers, members of governing board, and holders of 1% or more ownership interest, if any. Use one column for each individual or entity. Attach supplemental pages, if necessary. [Enter Owner Information] Owner Information List officers, members of governing board, and holders of 1% or more ownership interest, if any. Use one column for each individual or entity. Attach supplemental pages if necessary. (Read carefully - The numbered items below refer to line numbers in the following table.) a. Name and address of officer, member of governing board, and holders of 1% or more ownership interest (if other than individual also show name, address and citizenship of natural person authorized to vote the interest). List officers first, then board members, and thereafter, holders of 1% or more ownership interest, if any. b. Citizenship. c. Office held. d. Percent of interest held. e. Principal profession or f. By whom appointed or elected. g. Existing interests in any other broadcast station, including the nature and size of such interests. a. Name and Address. BRADBURY ANDERSON, AMERICAN PUBLIC MEDIA GROUP, 480 CEDAR STREET, SAINT PAUL, MN & CHAIR e. Principal profession or RETIRED g. Existing interests LICENSEE OF WKCP IN MIAMI, FL, TRUSTEE OF MINNESOTA PUBLIC RADIO, LICENSEE OF NUMEROUS PUBLIC RADIO STATIONS, SEE EXHIBIT FILED WITH OWNERSHIP REPORT BOA AVU. 2 of 6 8/3/2015 8:13 AM

11 3 of 6 8/3/2015 8:13 AM a. Name and Address. JANET DOLAN, AMERICAN PUBLIC MEDIA GROUP, 480 CEDAR STREET, SAINT PAUL, MN g. Existing interests LICENSEE OF WKCP IN MIAMI, FL, TRUSTEE OF MINNESOTA PUBLIC RADIO, LICENSEE OF NUMEROUS PUBLIC RADIO STATIONS, SEE EXHIBIT FILED WITH OWNERSHIP REPORT BOA AVU. a. Name and Address. IAN FRIENDLY, AMERICAN PUBLIC MEDIA GROUP, 480 CEDAR STREET, SAINT PAUL, MN & VICE CHAIR e. Principal profession or RETIRED g. Existing interests LICENSEE OF WKCP IN MIAMI, FL, TRUSTEE OF MINNESOTA PUBLIC RADIO, LICENSEE OF NUMEROUS PUBLIC RADIO STATIONS, SEE EXHIBIT FILED WITH OWNERSHIP REPORT BOA AVU. DUAL CITIZENSHIP IN US AND CANADA. a. Name and Address. STEVE FRITZE, AMERICAN PUBLIC MEDIA GROUP, 480 CEDAR STREET, SAINT PAUL, MN e. Principal profession or RETIRED g. Existing interests LICENSEE OF WKCP IN MIAMI, FL, TRUSTEE OF MINNESOTA PUBLIC RADIO, LICENSEE OF NUMEROUS PUBLIC RADIO STATIONS, SEE EXHIBIT FILED WITH OWNERSHIP REPORT BOA AVU. a. Name and Address. EMERY KOENIG, AMERICAN PUBLIC MEDIA GROUP, 480 CEDAR STREET, SAINT PAUL, MN & TREASURER g. Existing interests LICENSEE OF WKCP IN MIAMI, FL, TRUSTEE OF MINNESOTA PUBLIC RADIO, LICENSEE OF NUMEROUS PUBLIC RADIO STATIONS, SEE EXHIBIT FILED WITH OWNERSHIP REPORT BOA AVU. a. Name and Address. JONATHAN LOW, AMERICAN PUBLIC MEDIA GROUP, 480 CEDAR STREET, SAINT PAUL, MN 55101

12 4 of 6 8/3/2015 8:13 AM g. Existing interests LICENSEE OF WKCP IN MIAMI, FL, TRUSTEE OF MINNESOTA PUBLIC RADIO, LICENSEE OF NUMEROUS PUBLIC RADIO STATIONS, SEE EXHIBIT FILED WITH OWNERSHIP REPORT BOA AVU. TRUSTEE OF CSF, LICENSEE OF WNPS, FT MYERS, FL & WBPI, WEST PALM BEACH, FL. a. Name and Address. MARTI MORFITT, AMERICAN PUBLIC MEDIA GROUP, 480 CEDAR STREET, SAINT PAUL, MN & SECRETARY g. Existing interests LICENSEE OF WKCP IN MIAMI, FL, TRUSTEE OF MINNESOTA PUBLIC RADIO, LICENSEE OF NUMEROUS PUBLIC RADIO STATIONS, SEE EXHIBIT FILED WITH OWNERSHIP REPORT BOA AVU. a. Name and Address. ANA VALDEZ, AMERICAN PUBLIC MEDIA GROUP, 480 CEDAR STREET, SAINT PAUL, MN g. Existing interests LICENSEE OF WKCP IN MIAMI, TRUSTEE OF SOUTHERN CALIFORNIA PUBLIC RADIO, LICENSEE OF KVLA, COACHELLA, CA & KJAI OJAI, CA.TRUSTEE OF MINNESOTA PUBLIC RADIO, LICENSEE OF NUMEROUS PUBLIC RADIO STATIONS, SEE EXHIBIT FILED WITH OWNERSHIP REPORT BOA AVU. a. Name and Address. JON MCTAGGART, AMERICAN PUBLIC MEDIA GROUP, 480 CEDAR STREET, SAINT PAUL, MN c. Office held. PRESIDENT & CEO g. Existing interests LIC OF WKCP IN MIAMI, FL; TRUSTEE & ST OFF SCPR, LIC OF KVLA, COACHELLA CA & KJAI, OJA, CA; MPR, LIC OF NUMEROUS PUBLIC RADIO STATIONS, SEE EXHIBIT FILED WITH OWNERSHIP RPT BOA AVU; & CSF, LIC OF WNPS, FT MYERS, FL & WPBI, W PALM BEACH, FL. a. Name and Address. MORRIS GOODWIN, AMERICAN PUBLIC MEDIA GROUP, 480 CEDAR STREET, SAINT PAUL, MN 55101

13 5 of 6 8/3/2015 8:13 AM c. Office held. STAFF OFFICER f. By whom appointed or elected. PRESIDENT g. Existing interests LIC OF WKCP IN MIAMI, FL; ST OFF SCPR, LIC OF KVLA, COACHELLA CA & KJAI, OJA, CA; MPR, LIC OF NUMEROUS PUBLIC RADIO STATIONS, SEE EXHIBIT FILED WITH OWNERSHIP RPT BOA AVU; & CSF, LIC OF WNPS, FT MYERS, FL & WPBI, W PALM BEACH, FL.. a. Name and Address. DAVID KANSAS, AMERICAN PUBLIC MEDIA GROUP, 480 CEDAR STREET, SAINT PAUL, MN c. Office held. STAFF OFFICER f. By whom appointed or elected. PRESIDENT g. Existing interests LIC OF WKCP IN MIAMI, FL; ST OFF SCPR, LIC OF KVLA, COACHELLA CA & KJAI, OJA, CA; MPR, LIC OF NUMEROUS PUBLIC RADIO STATIONS, SEE EXHIBIT FILED WITH OWNERSHIP RPT BOA AVU; & CSF, LIC OF WNPS, FT MYERS, FL & WPBI, W PALM BEACH, FL. a. Name and Address. SYLVIA STROBEL, AMERICAN PUBLIC MEDIA GROUP, 480 CEDAR STREET, SAINT PAUL, MN c. Office held. STAFF OFFICER f. By whom appointed or elected. PRESIDENT g. Existing interests LIC OF WKCP IN MIAMI, FL; ST OFF SCPR, LIC OF KVLA, COACHELLA CA & KJAI, OJA, CA; MPR, LIC OF NUMEROUS PUBLIC RADIO STATIONS, SEE EXHIBIT FILED WITH OWNERSHIP RPT BOA AVU; & CSF, LIC OF WNPS, FT MYERS, FL & WPBI, W PALM BEACH, FL. SECTION III - CERTIFICATION I certify that I am SENIOR VICE PRESIDENT (Official Title) of AMERICAN PUBLIC MEDIA GROUP (Exact legal title or name of respondent) and that I have examined this Report and that to the best of my knowledge and belief, all statements in this Report are true, correct and complete.

14 6 of 6 8/3/2015 8:13 AM (Date of certification must be within 60 days of the date shown in Question 4, Section II and in no event prior to that date.) Signature SYLVIA STROBEL Telephone Number of Respondent (Include area code) Date 7/31/2015 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). Exhibits

FCC 323-E Ownership Report For Noncommercial Educational Broadcast Station

FCC 323-E Ownership Report For Noncommercial Educational Broadcast Station DBS Print Federal Communications Commission Washington, D.C. 20554 Approved by OMB 3060-0084 (June 2002) FCC 323-E Ownership Report For Noncommercial Educational Broadcast Station Read INSTRUCTIONS Before

More information

FCC 323-E Ownership Report For Noncommercial Educational Broadcast Station

FCC 323-E Ownership Report For Noncommercial Educational Broadcast Station Federal Communications Commission Washington, D.C. 20554 Approved by OMB 3060-0084 (June 2002) FCC 323-E Ownership Report For Noncommercial Educational Broadcast Station Read INSTRUCTIONS Before Filling

More information

Approved by OMB (September 2009)

Approved by OMB (September 2009) 1 of 5 10/31/2016 8:06 AM Federal Communications Commission Washington, D.C. 20554 FCC 345 Approved by OMB 3060-0075 (September 2009) APPLICATION FOR TRANSFER OF CONTROL OF A CORPORATE LICENSEE OR PERMITTEE,

More information

FCC 323-E Ownership Report For Noncommercial Educational Broadcast Station

FCC 323-E Ownership Report For Noncommercial Educational Broadcast Station DBS Print Federal Communications Commission Washington, D.C. 20554 Approved by OMB 3060-0084 (June 2002) FCC 323-E Ownership Report For Noncommercial Educational Broadcast Station Read INSTRUCTIONS Before

More information

CDBS Print http://fjallfoss.fcc.gov/cgi-bin/ws.exe/prod/cdbs/forms/prod/cdbsmenu.hts?context=25&f... Page 1 of 6 10/14/2008 Federal Communications Commission Washington, D.C. 20554 FCC 345 Section I -

More information

Approved by OMB (January 2001)

Approved by OMB (January 2001) Federal Communications Commission Washington, D.C. 20554 FCC 345 Section I - General Information 1. Legal Name of the Applicant EDGEWATER BROADCASTING, INC. Mailing Address P.O. BOX 5725 Approved by OMB

More information

Page 1 of 4 Federal Communications Commission Washington, D.C. 20554 FCC 303-S Approved by OMB 3060-0110 (March 2011) APPLICATION FOR RENEWAL OF BROADCAST STATION LICENSE Read INSTRUCTIONS Before Filling

More information

Approved by OMB (October 2009)

Approved by OMB (October 2009) Federal Communications Commission Washington, D.C. 20554 FCC 349 Approved by OMB 3060-0405 (October 2009) FOR FCC USE ONLY APPLICATION FOR AUTHORITY TO CONSTRUCT OR MAKE CHANGES IN AN FM TRANSLATOR OR

More information

Reference Copy Only. Do Not Mail to the FCC as an Application.

Reference Copy Only. Do Not Mail to the FCC as an Application. Only. Do Not Mail to the FCC as an Application. Submitted: 02/18/2010 at 15:19:56 File Number: 0004129997 FCC 601 FCC Application for Radio Service Authorization: Approved by OMB Form Wireless Telecommunications

More information

Approved by OMB (March 2011)

Approved by OMB (March 2011) Federal Communications Commission Washington, D.C. 20554 FCC 303-S Approved by OMB 3060-0110 (March 2011) APPLICATION FOR RENEWAL OF BROADCAST STATION LICENSE Read INSTRUCTIONS Before Filling Out Form

More information

Reference Copy Only. Do Not Mail to the FCC as an Application.

Reference Copy Only. Do Not Mail to the FCC as an Application. Only. Do Not Mail to the FCC as an Application. Submitted: 09/20/2005 at 13:50:38 File Number: 0002321287 FCC 601 FCC Application for Wireless Telecommunications Bureau Approved by OMB Main Form Radio

More information

Approved by OMB (July 2004)

Approved by OMB (July 2004) 1 of 4 4/18/2007 12:44 PM Federal Communications Commission Washington, D.C. 20554 FCC 303-S Approved by OMB 3060-0110 (July 2004) FOR FCC USE ONLY APPLICATION FOR RENEWAL OF BROADCAST STATION LICENSE

More information

FEDERATED NATIONAL HOLDING COMPANY (Exact name of registrant as specified in its charter)

FEDERATED NATIONAL HOLDING COMPANY (Exact name of registrant as specified in its charter) (State or other jurisdiction of incorporation) UNITED STATES SECURITIES AND EXCHANGE COMMISSION WASHINGTON, D.C. 20549 FORM 8-K CURRENT REPORT Pursuant to Section 13 or 15(d) of the Securities Exchange

More information

FCC 601 FCC Application for Radio Service Authorization: Approved by OMB

FCC 601 FCC Application for Radio Service Authorization: Approved by OMB FCC 601 FCC Application for Radio Service Authorization: Approved by OMB Main Form Wireless Telecommunications Bureau 3060-0798 Public Safety and Homeland Security Bureau 1) Radio Service Code: 1a) Existing

More information

FEDNAT HOLDING COMPANY (Exact name of registrant as specified in its charter)

FEDNAT HOLDING COMPANY (Exact name of registrant as specified in its charter) UNITED STATES SECURITIES AND EXCHANGE COMMISSION WASHINGTON, D.C. 20549 FORM 8-K CURRENT REPORT Pursuant to Section 13 or 15(d) of the Securities Exchange Act of 1934 Date of Report: May 31, 2018 (Date

More information

UNITED STATES SECURITIES AND EXCHANGE COMMISSION WASHINGTON, DC FORM 8-K

UNITED STATES SECURITIES AND EXCHANGE COMMISSION WASHINGTON, DC FORM 8-K UNITED STATES SECURITIES AND EXCHANGE COMMISSION WASHINGTON, DC 20549 FORM 8-K CURRENT REPORT Pursuant to Section 13 or 15(d) of the Securities Exchange Act of 1934 Date of report (Date of earliest event

More information

STATE OF FLORIDA OFFICE OF FINANCIAL REGULATION APPLICATION FOR CONSUMER FINANCE COMPANY LICENSE CHAPTER 516, FLORIDA STATUTES

STATE OF FLORIDA OFFICE OF FINANCIAL REGULATION APPLICATION FOR CONSUMER FINANCE COMPANY LICENSE CHAPTER 516, FLORIDA STATUTES STATE OF FLORIDA OFFICE OF FINANCIAL REGULATION APPLICATION FOR CONSUMER FINANCE COMPANY LICENSE CHAPTER 516, FLORIDA STATUTES GENERAL INSTRUCTIONS Form OFR-516-01 is the form used by Consumer Finance

More information

Please mail your completed application, documentation and required fee(s) to: 2601 Blair Stone Road Tallahassee, Fl

Please mail your completed application, documentation and required fee(s) to: 2601 Blair Stone Road Tallahassee, Fl State of Florida Department of Business and Professional Regulation Board of Auctioneers Application for Auction Business Licensure Form # DBPR AU-4155 1 of 7 APPLICATION CHECKLIST IMPORTANT Submit all

More information

APPLICATION CHECKLIST IMPORTANT Submit all items on the checklist below with your application to ensure faster processing. APPLICATION REQUIREMENTS

APPLICATION CHECKLIST IMPORTANT Submit all items on the checklist below with your application to ensure faster processing. APPLICATION REQUIREMENTS State of Florida Department of Business and Professional Regulation Florida Real Estate Appraisal Board Application for Registering an Appraisal Management Company Form # DBPR FREAB-1 1 of 10 APPLICATION

More information

FITBIT INC Reported by FRIEDMAN ERIC N.

FITBIT INC Reported by FRIEDMAN ERIC N. FITBIT INC Reported by FORM 3 (Initial Statement of Beneficial ) Filed 06/17/15 for the Period Ending 06/17/15 Address 405 HOWARD STREET Telephone 415-513-1000 CIK 0001447599 Symbol FIT SIC Code 3571 -

More information

Starwood Real Estate Income Trust, Inc.

Starwood Real Estate Income Trust, Inc. As filed with the Securities and Exchange Commission on April 2, 2018 Registration No. 333-220997 UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549 Post-Effective Amendment No. 1

More information

Feedback on the attached documents should be sent to the National Center on Full Faith and Credit at 800/ , ext. 2 or

Feedback on the attached documents should be sent to the National Center on Full Faith and Credit at 800/ , ext. 2 or The Honorable Amy Karan, Administrative Judge of the 11 th Judicial Circuit's dedicated Domestic Violence Court (Protection Order and Criminal) in Miami, FL, has crafted comprehensive procedures and forms

More information

State of Florida Department of Business and Professional Regulation Board of Professional Geologists

State of Florida Department of Business and Professional Regulation Board of Professional Geologists State of Florida Department of Business and Professional Regulation Board of Professional Geologists Application for License from Null and Void (Expired License) Form # DBPR PG 4705 1 of 7 APPLICATION

More information

UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C FORM 8-K

UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C FORM 8-K UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549 FORM 8-K CURRENT REPORT PURSUANT TO SECTION 13 OR 15(D) OF THE SECURITIES EXCHANGE ACT OF 1934 Date of Report (Date of earliest event

More information

STATE OF FLORIDA OFFICE OF FINANCIAL REGULATION. Application for Registration as Consumer Collection Agency Chapter 559 Part VI, Florida Statutes

STATE OF FLORIDA OFFICE OF FINANCIAL REGULATION. Application for Registration as Consumer Collection Agency Chapter 559 Part VI, Florida Statutes STATE OF FLORIDA OFFICE OF FINANCIAL REGULATION Application for Registration as Consumer Collection Agency Chapter 559 Part VI, Florida Statutes Consumer Collection Agency Consumer collection agency means

More information

When Should I Use Form I-824? How Do I File Form I-824? If you are requesting:

When Should I Use Form I-824? How Do I File Form I-824? If you are requesting: U.S. Department of Homeland Security Bureau of Citizenship and Immigration Services OMB No. 1615-0044: Expires 06/30/07 I-824, Application for Action on an Approved Application or Petition Instructions

More information

STATE OF MISSISSIPPI Department of Banking and Consumer Finance Post Office Box Jackson, Mississippi

STATE OF MISSISSIPPI Department of Banking and Consumer Finance Post Office Box Jackson, Mississippi FOR DEPARTMENT USE ONLY LICENSE NUMBER LICENSE EXPIRES TP STATE OF MISSISSIPPI Department of Banking and Consumer Finance Post Office Box 12129 Jackson, Mississippi 39236-2129 Title Pledge License Application

More information

FAMILY COURT SERVICES - ROOM WEST ADAMS STREET, JACKSONVILLE, FL (904) CHECKLIST FOR: MOTION FOR CIVIL CONTEMPT/ENFORCEMENT

FAMILY COURT SERVICES - ROOM WEST ADAMS STREET, JACKSONVILLE, FL (904) CHECKLIST FOR: MOTION FOR CIVIL CONTEMPT/ENFORCEMENT FAMILY COURT SERVICES - ROOM 2150 501 WEST ADAMS STREET, JACKSONVILLE, FL 32202 (904) 255-1060 CHECKLIST FOR: MOTION FOR CIVIL CONTEMPT/ENFORCEMENT Use this form to ask the court to enforce a prior court

More information

EMPLOYMENT/CONTRACTOR APPLICATION

EMPLOYMENT/CONTRACTOR APPLICATION For Official Use Only Date Received:, 2013 Reviewed by: Comments: INTERVIEWED BY: TRAINING RIDEALONG: SUBMITTED MVR TO INSURANCE: DATE: MVR QUALIFY?: EMPLOYMENT/CONTRACTOR APPLICATION Payback Repo Inc.

More information

Are There Cases When You Should Not Use This Form? What Information Is Needed to Search for USCIS Records? Verification of Identity in Person.

Are There Cases When You Should Not Use This Form? What Information Is Needed to Search for USCIS Records? Verification of Identity in Person. Department of Homeland Security U.S. Citizenship and Immigration Services OMB No. 1653-0030; Expires 08/31/05 G-639, Freedom of Information/ Privacy Act Request Instructions NOTE: Please read all Instructions

More information

THIS IS A COURT-APPROVED NOTICE, NOT A SOLICITATION FROM AN ATTORNEY. I. WHAT IS THIS ABOUT?

THIS IS A COURT-APPROVED NOTICE, NOT A SOLICITATION FROM AN ATTORNEY. I. WHAT IS THIS ABOUT? DATE: October 23, 2017 IF YOU HAVE BEEN IN RECEIPT OF BENEFITS FROM THE CORAL GABLES RETIREMENT SYSTEM FOR A FULL YEAR PRECEDING JANUARY 1, 2014, OR ARE A BENEFICIARY OF SOMEONE WHO HAS, YOU COULD RECEIVE

More information

State of Florida Department of Business and Professional Regulation Division of Drugs, Devices, and Cosmetics

State of Florida Department of Business and Professional Regulation Division of Drugs, Devices, and Cosmetics State of Florida Department of Business and Professional Regulation Division of Drugs, Devices, and Cosmetics Application for Permit as an Over-The-Counter Drug Manufacturer Form.: DBPR-DDC-205 APPLICATION

More information

What Documentation Must You Include If You Are Submitting This Form With Form I-485?

What Documentation Must You Include If You Are Submitting This Form With Form I-485? U.S. Department of Justice Immigration and Naturalization Service OMB No. 1115-0053 (Expires 05-31-05) Supplement A to Form I-485 Adjustment of Status Under Section 245(i) Only use this form if you are

More information

THE COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF PUBLIC SAFETY AND SECURITY Department of Criminal Justice Information Services

THE COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF PUBLIC SAFETY AND SECURITY Department of Criminal Justice Information Services THE COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF PUBLIC SAFETY AND SECURITY Department of Criminal Justice Information Services 200 Arlington Street, Suite 2200, Chelsea, MA 02150 mass.gov/cjis TTY:

More information

Process for Licensing for General Mobile Radio Service (GMRS)

Process for Licensing for General Mobile Radio Service (GMRS) The United States permits use by an adult individual who possesses a valid GMRS license, as well as his or her immediate family members. Immediate relatives of the GMRS system licensee are entitled to

More information

APPLICATION CHECKLIST IMPORTANT Submit all items on the checklist below with your application to ensure faster processing.

APPLICATION CHECKLIST IMPORTANT Submit all items on the checklist below with your application to ensure faster processing. 1 of 7 State of Florida Department of Business and Professional Regulation Board of Cosmetology Application for License/ Registration from Null and Void (Expired License/Registration) Form # DBPR COSMO

More information

INFORMATION AND INSTRUCTION FOR FORWARDING CENTER AUTHORITY (FC)

INFORMATION AND INSTRUCTION FOR FORWARDING CENTER AUTHORITY (FC) INFORMATION AND INSTRUCTION FOR FORWARDING CENTER AUTHORITY (FC) FORWARDING CENTER AUTHORITY- Allows the holder, who is a member of the manufacturing tier who is transporting alcoholic beverages into the

More information

APPLICATION CHECKLIST IMPORTANT Submit all items on the checklist below with your application to ensure faster processing.

APPLICATION CHECKLIST IMPORTANT Submit all items on the checklist below with your application to ensure faster processing. State of Florida Department of Business and Professional Regulation Florida Real Estate Appraisal Board Application for Certified Appraiser by Reciprocity Form # DBPR FREAB 12 1 of 7 APPLICATION CHECKLIST

More information

INFORMATION AND INSTRUCTION FOR NONRESIDENT SELLER S PERMIT, NONRESIDENT BREWER S PERMIT, AND NONRESIDENT MANUFACTURER S LICENSE

INFORMATION AND INSTRUCTION FOR NONRESIDENT SELLER S PERMIT, NONRESIDENT BREWER S PERMIT, AND NONRESIDENT MANUFACTURER S LICENSE INFORMATION AND INSTRUCTION FOR NONRESIDENT SELLER S PERMIT, NONRESIDENT BREWER S PERMIT, AND NONRESIDENT MANUFACTURER S LICENSE FORM L-NRES-I (10/2017) NONRESIDENT SELLER S PERMIT (S) (Wine, Distilled

More information

State of Florida Department of Business and Professional Regulation Division of Drugs, Devices, and Cosmetics

State of Florida Department of Business and Professional Regulation Division of Drugs, Devices, and Cosmetics State of Florida Department of Business and Professional Regulation Division of Drugs, Devices, and Cosmetics Application for Permit as a Prescription Drug Manufacturer Form.: DBPR-DDC-201 APPLICATION

More information

Exxon Mobil Corporation (Exact name of registrant as specified in its charter)

Exxon Mobil Corporation (Exact name of registrant as specified in its charter) 8 K 1 d886514d8k.htm FORM 8 K UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549 FORM 8 K CURRENT REPORT Pursuant to Section 13 or 15(d) of the Securities Exchange Act of 1934 Date

More information

APPLICATION CHECKLIST - IMPORTANT - Submit all items on the checklist below with your application to ensure faster processing.

APPLICATION CHECKLIST - IMPORTANT - Submit all items on the checklist below with your application to ensure faster processing. State of Florida Department of Business and Professional Regulation Board of Landscape Architecture Application for Individual Licensure: Reinstate Null and Void License Form # DBPR LA 5 1 of 7 APPLICATION

More information

FLORIDA DEPARTMENT OF STATE DIVISION OF CORPORATIONS WANTS YOU TO KNOW

FLORIDA DEPARTMENT OF STATE DIVISION OF CORPORATIONS WANTS YOU TO KNOW FLORIDA DEPARTMENT OF STATE DIVISION OF CORPORATIONS WANTS YOU TO KNOW Business Identity Theft is a broad term that encompasses a wide variety of crimes involving the unauthorized use of a business identity.

More information

CITY OF LAKE WORTH, TEXAS APPLICATION FOR EMPLOYMENT An Equal Opportunity Employer

CITY OF LAKE WORTH, TEXAS APPLICATION FOR EMPLOYMENT An Equal Opportunity Employer CITY OF LAKE WORTH, TEXAS APPLICATION FOR EMPLOYMENT An Equal Opportunity Employer It is the policy of the City of Lake Worth not to discriminate in its hiring or employment practices on the basis of race,

More information

EMPLOYEE UPDATE FORM

EMPLOYEE UPDATE FORM EMPLOYEE UPDATE FORM Date Submitted: First Name M.I. Last Name Address City State Zip County SSN DOB E-Mail Hire Date: Termination Date: Change Date: Auth. Signature Marital Status: Married Single Gender:

More information

Sudbury Police Department

Sudbury Police Department Sudbury Police Department 75 Hudson Road Sudbury, MA 01776 Business (978) 443-1042 Fax (978) 443-1045 APPLICATION FOR NEW/RENEWAL OF FIREARMS IDENTIFICATION CARD OR LICENSE TO CARRY FIREARMS NEW APPLICANTS

More information

UNITED STATES SECURITIES AND EXCHANGE COMMISSION WASHINGTON, D.C FORM 8-K

UNITED STATES SECURITIES AND EXCHANGE COMMISSION WASHINGTON, D.C FORM 8-K UNITED STATES SECURITIES AND EXCHANGE COMMISSION WASHINGTON, D.C. 20549 FORM 8-K CURRENT REPORT Pursuant to Section 13 or 15(d) of the Securities Exchange Act of 1934 Date of Report (Date of earliest event

More information

Old Dominion Freight Line, Inc.

Old Dominion Freight Line, Inc. UNITED STATES SECURITIES AND EXCHANGE COMMISSION WASHINGTON, D.C. 20549 FORM 8-K CURRENT REPORT Pursuant to Section 13 or 15(d) of the Securities Exchange Act of 1934 Date of Report (Date of Earliest Event

More information

NATURE S SUNSHINE PRODUCTS, INC. (Exact name of registrant as specified in its charter)

NATURE S SUNSHINE PRODUCTS, INC. (Exact name of registrant as specified in its charter) As filed with the Securities and Exchange Commission on June 5, 2013 Registration No. 333- UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549 FORM S-8 REGISTRATION STATEMENT Under

More information

APPLICATION CHECKLIST IMPORTANT Submit all items on the checklist below with your application to ensure faster processing.

APPLICATION CHECKLIST IMPORTANT Submit all items on the checklist below with your application to ensure faster processing. State of Florida Department of Business and Professional Regulation Board of Architecture and Interior Design Application for Licensure by NCARB Endorsement Form # DBPR AR 6 1 of 6 APPLICATION CHECKLIST

More information

Part I To Be Completed by ALL Applicants

Part I To Be Completed by ALL Applicants Application for a Farm Labor Contractor or Farm Labor Contractor Employee Certificate of Registration Migrant and Seasonal Agricultural Worker Protection Act Wage and Hour Division OMB No. 1235-0016 Expires:

More information

INSTRUCTIONS FOR FLORIDA SUPREME COURT APPROVED FAMILY LAW FORM (b) MOTION FOR ORDER PERMITTING RELOCATION BY AGREEMENT (11/15)

INSTRUCTIONS FOR FLORIDA SUPREME COURT APPROVED FAMILY LAW FORM (b) MOTION FOR ORDER PERMITTING RELOCATION BY AGREEMENT (11/15) INSTRUCTIONS FOR FLORIDA SUPREME COURT APPROVED FAMILY LAW FORM 12.950(b) MOTION FOR ORDER PERMITTING RELOCATION BY AGREEMENT (11/15) When should this form be used? This form should be used when the parents

More information

State of Florida Department of Business and Professional Regulation Division of Drugs, Devices, and Cosmetics

State of Florida Department of Business and Professional Regulation Division of Drugs, Devices, and Cosmetics State of Florida Department of Business and Professional Regulation Division of Drugs, Devices, and Cosmetics Application for Permit as a nresident Prescription Drug Manufacturer Form.: DBPR-DDC-202 APPLICATION

More information

Tennessee Athlete Agent Application for Registration or Renewal

Tennessee Athlete Agent Application for Registration or Renewal Tre Hargett Secretary of State Tennessee Athlete Agent Application for Registration or Renewal Division of Charitable Solicitations, Fantasy Sports, and Gaming Department of State State of Tennessee 312

More information

State of Florida Department of Business and Professional Regulation Division of Drugs, Devices, and Cosmetics

State of Florida Department of Business and Professional Regulation Division of Drugs, Devices, and Cosmetics State of Florida Department of Business and Professional Regulation Division of Drugs, Devices, and Cosmetics Application for Permit as a nresident Prescription Drug Manufacturer Virtual Form.: DBPR-DDC-236

More information

State of Illinois Circuit Court of Cook County INFORMATION PACKET GUARANTORS BOND CERTIFICATES *** Honorable Timothy C.

State of Illinois Circuit Court of Cook County INFORMATION PACKET GUARANTORS BOND CERTIFICATES *** Honorable Timothy C. State of Illinois Circuit Court of Cook County INFORMATION PACKET GUARANTORS BOND CERTIFICATES *** Honorable Timothy C. Evans Chief Judge The Civil Surety Information Packet Includes the Following: (1)

More information

APPLICATION CHECKLIST IMPORTANT Submit all items on the checklist below with your application to ensure faster processing.

APPLICATION CHECKLIST IMPORTANT Submit all items on the checklist below with your application to ensure faster processing. State of Florida Department of Business and Professional Regulation Asbestos Licensing Unit Application for Financially Responsible Officer Form # DBPR ALU 5 1 of 9 APPLICATION CHECKLIST IMPORTANT Submit

More information

INSTRUCTIONS FOR FLORIDA SUPREME COURT APPROVED FAMILY LAW FORM (a) PETITION FOR CHANGE OF NAME (ADULT) (11/15)

INSTRUCTIONS FOR FLORIDA SUPREME COURT APPROVED FAMILY LAW FORM (a) PETITION FOR CHANGE OF NAME (ADULT) (11/15) INSTRUCTIONS FOR FLORIDA SUPREME COURT APPROVED FAMILY LAW FORM 12.982(a) PETITION FOR CHANGE OF NAME (ADULT) When should this form be used? This form should be used when an adult wants the court to change

More information

UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C FORM 10-K

UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C FORM 10-K UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549 FORM 10-K OMB APPROVAL OMB Number: 3235-0063 Expires: March 31, 2018 Estimated average burden hours per response.... 1,998.78 A.

More information

CLS HOLDINGS USA, INC. (Exact name of registrant as specified in its charter)

CLS HOLDINGS USA, INC. (Exact name of registrant as specified in its charter) UNITED STATES SECURITIES AND EXCHANGE COMMISSION WASHINGTON, D.C. 20549 FORM 8-K CURRENT REPORT Pursuant to Section 13 or 15(d) of the Securities Exchange Act of 1934 Date of Report (Date of earliest event

More information

GOVERNMENT OF INDIA, MINISTRY OF EXTERNAL AFFAIRS PASSPORT APPLICATION FORM

GOVERNMENT OF INDIA, MINISTRY OF EXTERNAL AFFAIRS PASSPORT APPLICATION FORM File Number (For Office Use Only) GOVERNMENT OF INDIA, MINISTRY OF EXTERNAL AFFAIRS PASSPORT APPLICATION FORM Please read the Passport Instruction Booklet carefully before filling the form. Fill this form

More information

APPLICATION CHECKLIST IMPORTANT

APPLICATION CHECKLIST IMPORTANT State of Florida Department of Business and Professional Regulation Division of Professions: Talent Agencies Application for Licensure as a Talent Agency Form # DBPR TA-1 APPLICATION CHECKLIST IMPORTANT

More information

SB 908 AN ACT. The General Assembly of the Commonwealth of Pennsylvania hereby enacts as follows:

SB 908 AN ACT. The General Assembly of the Commonwealth of Pennsylvania hereby enacts as follows: AUCTIONEER AND AUCTION LICENSING ACT - AUCTIONEER AND APPRENTICE AUCTIONEER LICENSES Act of Oct. 8, 2008, P.L. 1080, No. 89 Cl. 63 Session of 2008 No. 2008-89 SB 908 AN ACT Amending the act of December

More information

When should this form be used? IMPORTANT INFORMATION REGARDING E-FILING. What should I do next?

When should this form be used? IMPORTANT INFORMATION REGARDING E-FILING. What should I do next? INSTRUCTIONS FOR FLORIDA SUPREME COURT APPROVED FAMILY LAW FORM 12.941(a), VERIFIED MOTION FOR TEMPORARY INJUNCTION TO PREVENT REMOVAL OF MINOR CHILD(REN) AND/OR DENIAL OF PASSPORT SERVICES (11/15) When

More information

Employment Application

Employment Application Employment Application CorrBox INCORPORATED 24551 Del Prado #639 Dana Point, CA 92629 Tel. (949) 248-5880 Fax. (949) 373-3256 info@corrbox.com Applicant Information Last First M.I. Date: Street Address

More information

Provisional English Version. September, 2011 Revised in March, 2015 Japan Patent Office

Provisional English Version. September, 2011 Revised in March, 2015 Japan Patent Office Provisional English Version September, 2011 Revised in March, 2015 Japan Patent Office Contents 1. Outline of the Article 30 revised in 2011 1 2. Procedural requirements to seek the application of Article

More information

Please mail your completed application, documentation and required fee(s) to: 2601 Blair Stone Road Tallahassee, Fl

Please mail your completed application, documentation and required fee(s) to: 2601 Blair Stone Road Tallahassee, Fl State of Florida Board of Auctioneers Application for Initial Licensure as Auctioneer Form # DBPR AU-4153 1 of 9 APPLICATION CHECKLIST IMPORTANT Submit items on the checklist below with your application

More information

BIDDER/OFFEROR CERTIFICATION FORM

BIDDER/OFFEROR CERTIFICATION FORM BIDDER/OFFEROR CERTIFICATION FORM COMPLETION The person(s) completing this form must be knowledgeable about the bidder's/offeror's business and operations. RESPONSES Every question must be answered. Each

More information

GROVE COMMUNITY DISTRICT OKEECHOBEE COUNTY LANDOWNERS MEETING & REGULAR BOARD MEETING NOVEMBER 6, :00 P.M.

GROVE COMMUNITY DISTRICT OKEECHOBEE COUNTY LANDOWNERS MEETING & REGULAR BOARD MEETING NOVEMBER 6, :00 P.M. GROVE COMMUNITY DISTRICT OKEECHOBEE COUNTY LANDOWNERS MEETING & REGULAR BOARD MEETING NOVEMBER 6, 2018 2:00 P.M. Special District Services, Inc. The Oaks Center 2501A Burns Road Palm Beach Gardens, FL

More information

State of Florida Department of Business and Professional Regulation Division of Drugs, Devices, and Cosmetics

State of Florida Department of Business and Professional Regulation Division of Drugs, Devices, and Cosmetics State of Florida Department of Business and Professional Regulation Division of Drugs, Devices, and Cosmetics Application for Third Party Logistic Provider Permit Form.: DBPR-DDC-220 APPLICATION CHECKLIST

More information

INSTRUCTION SHEET. Please be sure to read the following information before you fill out the attached affidavit complaint form:

INSTRUCTION SHEET. Please be sure to read the following information before you fill out the attached affidavit complaint form: OFFICE OF THE ATTORNEY GENERAL PL-01 The Capitol Tallahassee, FL 32399-1050 PAM BONDI Phone (850) 414-3300 Fax (850) 488-4483 ATTORNEYGENERAL http://www.myfloridalegal.com STATE OF FLORIDA INSTRUCTION

More information

Northborough Police Department 211 Main Street Northborough, Massachusetts Fax

Northborough Police Department 211 Main Street Northborough, Massachusetts Fax Northborough Police Department 211 Main Street Northborough, Massachusetts 01532 508-393-1515 Fax 508-393-1519 William E. Lyver, Jr. Chief of Police TO: FROM: RE: Lt. Joseph G. Galvin Executive Officer

More information

IN-LIEU OF PARKING FEE PAYMENT AGREEMENT

IN-LIEU OF PARKING FEE PAYMENT AGREEMENT Prepared by: RETURN: Noel Pfeffer,, Esq. City Attorney's Office 200 N.W. 1st Avenue Delray Beach, Florida 33444 IN-LIEU OF PARKING FEE PAYMENT AGREEMENT THIS AGREEMENT ( Agreement ) is made as of the day

More information

GRAND BAY AT DORAL COMMUNITY DEVELOPMENT DISTRICT

GRAND BAY AT DORAL COMMUNITY DEVELOPMENT DISTRICT GRAND BAY AT DORAL COMMUNITY DEVELOPMENT DISTRICT MIAMI-DADE COUNTY LANDOWNERS MEETING & REGULAR BOARD MEETING NOVEMBER 15, 2017 10:00 A.M. Special District Services, Inc. 6625 Miami Lakes Drive, Suite

More information

APPLICATION CHECKLIST IMPORTANT Submit all items on the checklist below with your application to ensure faster processing. APPLICATION REQUIREMENTS

APPLICATION CHECKLIST IMPORTANT Submit all items on the checklist below with your application to ensure faster processing. APPLICATION REQUIREMENTS State of Florida Building Code Administrators and Inspectors Board Application to Reinstate Null and Void Certification Form # DBPR BCAIB 9 1 of 5 APPLICATION CHECKLIST IMPORTANT Submit all items on the

More information

INSTRUCTIONS FOR FLORIDA SUPREME COURT APPROVED FAMILY LAW FORM (c) PETITION FOR CHANGE OF NAME (MINOR CHILD(REN)) (11/15)

INSTRUCTIONS FOR FLORIDA SUPREME COURT APPROVED FAMILY LAW FORM (c) PETITION FOR CHANGE OF NAME (MINOR CHILD(REN)) (11/15) INSTRUCTIONS FOR FLORIDA SUPREME COURT APPROVED FAMILY LAW FORM 12.982(c) PETITION FOR CHANGE OF NAME (MINOR CHILD(REN)) (11/15) When should this form be used? This form should be used when a parent or

More information

Employment Eligibility Verification Department of Homeland Security U.S. Citizenship and Immigration Services USCIS Form I-9 OMB No. 1615-0047 Expires 08/31/2019 START HERE: Read instructions carefully

More information

State of Florida Department of Business and Professional Regulation Division of Drugs, Devices, and Cosmetics. Form No.

State of Florida Department of Business and Professional Regulation Division of Drugs, Devices, and Cosmetics. Form No. State of Florida Department of Business and Professional Regulation Division of Drugs, Devices, and Cosmetics Application for Permit as a Diethyl Ether Manufacturer, Distributor, Dealer, or Purchaser Form

More information

ETA Form 9089 U.S. Department of Labor

ETA Form 9089 U.S. Department of Labor Please read and review the filing instructions before completing this form. A copy of the instructions can be found at http://workforcesecurity.doleta.gov/foreign/. Employing or continuing to employ an

More information

Page 1 of 5 8-K 1 form8k06113_05182011.htm UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549 FORM 8-K CURRENT REPORT Pursuant to Section 13 or 15(d) of the Securities Exchange Act

More information

STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION 2601 Blair Stone Road Tallahassee, FL

STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION 2601 Blair Stone Road Tallahassee, FL DBPR EL-4512 Historical Sketch STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION 2601 Blair Stone Road Tallahassee, FL 32399-0783 Rule 61G7-5.0012, Florida Administrative Code requires

More information

YOUR PARTNER FOR SOLID WASTE SOLUTIONS

YOUR PARTNER FOR SOLID WASTE SOLUTIONS YOUR PARTNER FOR SOLID WASTE SOLUTIONS The Solid Waste Authority of Palm Beach County (SWA) Governing Board approved Rule IV Standards and Criteria for Roll-off Collection Services formally implementing

More information

) ) ) ) ) ) ) ) ) ) ) ) ) ) ) ) ) ) ) ) ) ) ) )

) ) ) ) ) ) ) ) ) ) ) ) ) ) ) ) ) ) ) ) ) ) ) ) Case :-cv-0-dmg-e Document Filed // Page of Page ID #: 0 GERARD FOX LAW, P.C. GERARD P. FOX (SBN # gfox@gerardfoxlaw.com BELINDA M. VEGA (SBN # bvega@gerardfoxlaw.com 0 Century Park East, Suite 0 Los Angeles,

More information

INSTRUCTIONS FOR FLORIDA SUPREME COURT APPROVED FAMILY LAW FORM (c) PETITION FOR CHANGE OF NAME (MINOR CHILD(REN)) (02/18)

INSTRUCTIONS FOR FLORIDA SUPREME COURT APPROVED FAMILY LAW FORM (c) PETITION FOR CHANGE OF NAME (MINOR CHILD(REN)) (02/18) INSTRUCTIONS FOR FLORIDA SUPREME COURT APPROVED FAMILY LAW FORM 12982(c) PETITION FOR CHANGE OF NAME (MINOR CHILD(REN)) When should this form be used? This form should be used when parents want the court

More information

Instructor Information for Endorsement

Instructor Information for Endorsement SOUTH CAROLINA DEPARTMENT OF LABOR, LICENSING AND REGULATION SOUTH CAROLINA BOARD OF COSMETOLOGY POST OFFICE BOX 11329 COLUMBIA, SOUTH CAROLINA 29211-1329 (803) 896-4588 Email: BoardInfo@llr.sc.gov Instructor

More information

CL Notice of Change

CL Notice of Change Consultant Lobbyist Registration - tice of Change CL-10481-02 - tice of Change Status Active Registration Details Type of Lobbyist Registration Number Type of Registration Submission Date Official Filing

More information

- Page 1 SAMPLE EXAMINATION TYPE: RECIPROCAL SALESPERSON INSTRUCTIONS

- Page 1 SAMPLE EXAMINATION TYPE: RECIPROCAL SALESPERSON INSTRUCTIONS - Page 1 LN, FN MN CITY, XX XXXXX CANDIDATE ID: 000 EXAMINATION DATE: 4/24/2012 INSTRUCTIONS A. Attach an official Certificate of Licensure form (License History NOT A COPY OF YOUR REAL ESTATE LICENSE)

More information

Employment Application An Equal Opportunity Employer

Employment Application An Equal Opportunity Employer Employment Application An Equal Opportunity Employer AllianceHR New Hire Policy: Prior to the employee starting work, the Employee Application and the Employment Eligibility Form (I-9) must be completed

More information

DEPARTMENT OF PLANNING & DEVELOPMENT SERVICES. Notice to applicant: Please read the following:

DEPARTMENT OF PLANNING & DEVELOPMENT SERVICES. Notice to applicant: Please read the following: DEPARTMENT OF PLANNING & DEVELOPMENT SERVICES Application for a Conditional Use for office use only: CASE NO. FILED: BY: PARCEL ID NO. FILING FEE: $ FILING DEADLINE: PRE-APP MTG: LPA HEARING: BCC HEARING:

More information

State of Florida Department of Business and Professional Regulation Division of Drugs, Devices, and Cosmetics

State of Florida Department of Business and Professional Regulation Division of Drugs, Devices, and Cosmetics State of Florida Department of Business and Professional Regulation Division of Drugs, Devices, and Cosmetics Application for Permit as a Health Care Clinic Establishment Form No.: DBPR-DDC-224 APPLICATION

More information

INSTRUCTIONS FOR FLORIDA SUPREME COURT APPROVED FAMILY LAW FORM (a)(1), STEPPARENT ADOPTION: CONSENT AND WAIVER BY PARENT (11/15)

INSTRUCTIONS FOR FLORIDA SUPREME COURT APPROVED FAMILY LAW FORM (a)(1), STEPPARENT ADOPTION: CONSENT AND WAIVER BY PARENT (11/15) INSTRUCTIONS FOR FLORIDA SUPREME COURT APPROVED FAMILY LAW FORM 12.981(a)(1), STEPPARENT ADOPTION: CONSENT AND WAIVER BY PARENT (11/15) When should this form be used? This form is to be completed and signed

More information

Case 9:18-cv RLR Document 13 Entered on FLSD Docket 12/31/2018 Page 1 of 20

Case 9:18-cv RLR Document 13 Entered on FLSD Docket 12/31/2018 Page 1 of 20 Case 9:18-cv-81418-RLR Document 13 Entered on FLSD Docket 12/31/2018 Page 1 of 20 UNITED STATES DISTRICT COURT FOR THE SOUTHERN DISTRICT OF FLORIDA RM BROADCASTING, LLC 101 Waters Edge Drive Jupiter, Florida

More information

COCO PALMS COMMUNITY DEVELOPMENT DISTRICT

COCO PALMS COMMUNITY DEVELOPMENT DISTRICT COCO PALMS COMMUNITY DEVELOPMENT DISTRICT MIAMI-DADE COUNTY LANDOWNERS MEETING & REGULAR BOARD MEETING NOVEMBER 6, 2018 10:15 A.M. Special District Services, Inc. 6625 Miami Lakes Drive, Suite 374 Miami

More information

State of Illinois Circuit Court of Cook County INFORMATION PACKET CIVIL SURETIES *** Honorable Timothy C. Evans Chief Judge

State of Illinois Circuit Court of Cook County INFORMATION PACKET CIVIL SURETIES *** Honorable Timothy C. Evans Chief Judge State of Illinois Circuit Court of Cook County INFORMATION PACKET CIVIL SURETIES *** Honorable Timothy C. Evans Chief Judge INFORMATION PACKET FOR CIVIL SURETIES The Civil Surety Information Packet Includes

More information

NEW JERSEY BOARD OF PUBLIC UTILITIES 44 South Clinton Avenue 3 rd Floor, Suite 314, P.O. Box 350 Trenton, New Jersey

NEW JERSEY BOARD OF PUBLIC UTILITIES 44 South Clinton Avenue 3 rd Floor, Suite 314, P.O. Box 350 Trenton, New Jersey NEW JERSEY BOARD OF PUBLIC UTILITIES 44 South Clinton Avenue 3 rd Floor, Suite 314, P.O. Box 350 Trenton, New Jersey 08625-0350 ELECTRIC POWER and/or GAS SUPPLIER LICENSE RENEWAL APPLICATION Please Type

More information

TOWN OF WILMINGTON MASSACHUSETTS

TOWN OF WILMINGTON MASSACHUSETTS Chief Michael R. Begonis TOWN OF WILMINGTON MASSACHUSETTS POLICE DEPARTMENT One Adelaide Street Wilmington, MA 01887 978-658-5071 FAX 978-658-0035 NOTICE OF CHANGE TO FIREARMS APPLICATION PROCESS The following

More information

INSTRUCTIONS FOR FLORIDA SUPREME COURT APPROVED FAMILY LAW FORM (a) PETITION FOR CHANGE OF NAME (ADULT) (09/16)

INSTRUCTIONS FOR FLORIDA SUPREME COURT APPROVED FAMILY LAW FORM (a) PETITION FOR CHANGE OF NAME (ADULT) (09/16) INSTRUCTIONS FOR FLORIDA SUPREME COURT APPROVED FAMILY LAW FORM 12.982(a) PETITION FOR CHANGE OF NAME (ADULT) (09/16) When should this form be used? This form should be used when an adult wants the court

More information

Pine Tree Village Amended and Restated By-Laws

Pine Tree Village Amended and Restated By-Laws AMENDED AND RESTATED BYLAWS OF P.T.V. HOMEOWNER S ASSOCIATION, INC. (a Corporation Not-for-Profit) ARTICLE I Definitions As used in these Amended and Restated Bylaws of the Association, the following terms

More information

INSTRUCTIONS FOR FLORIDA SUPREME COURT APPROVED FAMILY LAW FORM (d) EMERGENCY VERIFIED MOTION FOR CHILD PICK-UP ORDER (11/15)

INSTRUCTIONS FOR FLORIDA SUPREME COURT APPROVED FAMILY LAW FORM (d) EMERGENCY VERIFIED MOTION FOR CHILD PICK-UP ORDER (11/15) INSTRUCTIONS FOR FLORIDA SUPREME COURT APPROVED FAMILY LAW FORM 12.941(d) EMERGENCY VERIFIED MOTION FOR CHILD PICK-UP ORDER (11/15) When should this form be used? You may use this form to request that

More information

HIGH RIDGE QUANTUM COMMUNITY DEVELOPMENT DISTRICT

HIGH RIDGE QUANTUM COMMUNITY DEVELOPMENT DISTRICT HIGH RIDGE QUANTUM COMMUNITY DEVELOPMENT DISTRICT PALM BEACH COUNTY LANDOWNERS MEETING & REGULAR BOARD MEETING NOVEMBER 14, 2018 8:30 A.M. Special District Services, Inc. The Oaks Center 2501A Burns Road

More information