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Information Station Specialists, Inc,
(mall) PO sort 61 -- (ship) 3366 SSA" Avenue —Zeeland, MI 494614
(phone) 816.772.2300 — (tie) 816.772.294d
(smelt) ill heRADIosoures.coj (webslle) w Av.th.RADlOsoures.t:orn
FCC License Application Questionnneire Fixed Point Station(s)
Please fill Out and faxhtrrlall back to I8& at 81e-772.2060, attention Bill Baker.
(bl I IQth BRAD lOso u roe. corn).
check here If you arc requesting a modification or a renewal of an existing FCC
IiceMs. If ao. sea section C.
Check here W you do n2s want MO to file Me sppllcetlon wllh the FCC, but only to
priP litre the engineering attachment for your agency to file.
A General Questions
Aarllleant Entity Who li applying for the license? List the name of the governmental entity, the
street i mailing address, city, elate, zip code, end 9sugn federal tax lb number (TIN/FEIN).
Entity Name: City of Miami Deprlrtnlsnt of Fire -Rescue (must be governmental)
Address, 1161 NW 7" $tnet, 3l Floor
City: Miami State: FL Zip: 33138
MUST INCLUDE Fed.Tax ID Number (TIN/EIN): 59-6000375
IF YOUR AGENCY HAS s Frequency Registration Number and Password already, list them
billows* we can moose end submit on your bell, Leave blank if not applicable.
Frequently Registration Number 00/2 3107 13 Password /2",q..77
NIRg Llst the name of the person (at the above address) whose name will appear an the
application, along with their title, phone, fox end email
Name: Joseph R. Fernandez Title: Aatilatent Fire Chief
Phone: (306) 416.6414
Fax: (303) 4004031 Email: Jrfemandetegai,rrlleml,H.ua
Pi # iDYe r sir"( Itage c f 7d$ 9$
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(Optional) autIs/nit Who should be notified once this application has been flied with the FCC?
List the persons name, street address with Yip code, telephone. fax and email. If Ihla will bo the
lama Perim you Identified above. please circle "SAME''.
Name: Kelly Penton SAME
Street Address & Zip Cods: 444 SW el Avenue. 9°` Floor
City: Miami State: FL Zip Code: 33130
Phone: (3015) 418.1036 Fax: (305) 400-S296 roust kpenton®oLmlarnl.fl.us
ERjD1 • ' CeMro1 The station(s) operation will be controlled from the following Ioegtlon:
Street Address: 444 SW 2' Avenue
Telephone number: (305) 418.1036
Nearest City: Miami County: MlamhOede
State: Fl,
Content Circle items that will be In the broadcast content of the station:
Triad i nce rend omdidlEihiirs I "
TreffIc hated ehEq,dianr.l�rodvlsoJJga I Avaijablitty o ,ropgl
Dlrfialion>r " "''
• Wels')hiartftlol�natlon
DE�s0001o,,e of lotri.PoI 1fRiecelt
B Antenna Information
Fixed point Fill out this section far each fJxed!p,alnt enterer' locallon,
Weight and type (circle) of support structure: 12 ft
premldss at approximately 30 ft) BUILDING
Consult with !S6 if structure is taller than 25',
also a hoes tower located on the
Other 6- 3 w+t►
Address or geographlo description; all other Iocadlons are yard style
Nearest City, County & State Nearest City: Miami County: MIamI•Dsde State: FL
Frequency Circle or write in the frequency you wish to apply for at this location. If you dv not
know the frequency or are unsure at this time, circle "NOT KNOWN". ( ISS will assist 1n
determining the best frequency, subject to your approval.)
530 1610 1620 Other Frequenc 16i90 NOT KNOWN
MUST INCLUDE Map Provide as an attachment a marked street or highway map showing the
proposed antenna location.
(Optional) Coordinates Provide the latitude and longitude of the fixed point antenna site:
N W
(Optional) Elevation (CIRCLE foot or meters)
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Sent By: ISS, Inc.;
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816 772 29de; Jan-14-05 11:04AM;
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C For Operators Who Are Modifying And/or Rtenawing Existing Licenses
If this application le for the modification and/or renewal of an extellrig license, first fill cut In Section A the "Applicant Entity' and Name" 'actions only.
Then, onry fill out other parts of this application which have changed and need updating, leaving
items which are staying condtanl blank.
Finally, list the following:
Calleign(e) of me radio stations to be renowad/madifled,
Location name (typle*lly city) of the station to be modlflod ,
D Special Temporary Assignment (STA)
The purpose of a STA is to provide • lioanae to cover the applicant whiio hie primary license
application Is pending or for a station that is to operate for only • limited period of lime. There iv a
charge for ISS to process and Ala the STA application on your behalf.
f1 your need for an STA Is to provide a Manse while your primary limns. appfioatlon le being
;ranted, please leave that section blank.
If your need for an STA to to provide a temporary license for a short period of time, state the
dates you would request for the STA; Starting: unknown at this time (perhaps January or
February, 2005) Ending: (e months max).
E Statement of Understanding
I understand that Information Station SPicialista Is not responsible for the approval or dlseppr>Dvel
of this license application by the Federal Communications Commission. If Granted, opandlon is
subject to changes In primary services on the AM broadcast band, and must aaconenodats those
changes. (For portable operations, this also Inoludss the aocommodallon of fixed-point TISIIIAR
changes,) I further state that the information provided h accurate, to the but of my knowledge,
and that I have the approval of the above -named governmental entity to provide this Information
on Its behalf. -
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