FCC Form 602 Main Form And Schedule A FEDERAL COMMUNICATIONS COMMISSION Approved by OMB 3060 – 0799 Information and Instructions Est. Avg. Burden Per Response: 1.5 hours FCC Ownership Disclosure Information for the Wireless Telecommunications Services NOTICE TO INDIVIDUALS REQUIRED BY THE PRIVACY ACT OF 1974 AND THE PAPERWORK REDUCTION ACT OF 1995 We have estimated that each response to this collection of information will take on average 1.5 hours. Our estimate includes the time to read the instructions, look through existing records, gather and maintain required data, and actually complete and review the form or response. If you have any comments on this estimate, or on how we can improve the collection and reduce the burden it causes you, please write the Federal Communications Commission, AMD-PERM, Washington, DC 20554, Paperwork Reduction Project (3060-0799). We will also accept your comments via the Internet if you send them to PRA@fcc.gov. Please do not send completed application forms to this address. You are not required to respond to a collection of information sponsored by the Federal government, and the government may not conduct or sponsor this collection unless it displays a currently valid OMB control number with this notice. This collection has been assigned OMB control number 3060-0799. The FCC is authorized under the Communications Act of 1934, as amended, to collect the personal information we request in this form. We will use the information you provide in evaluating pending licensing applications. If we believe there may be a violation or potential violation of a statute, FCC regulation, rule or order, your application may be referred to the Federal, state, or local agency responsible for investigating, prosecuting, enforcing or implementing the statute, rule, regulation or order. In certain cases, the information in your application may be disclosed to the Department of Justice or a court or adjudicative body when (a) the FCC; or (b) any employee of the FCC; or (c) the United States Government, is a party to a proceeding before the body or has an interest in the proceeding. All parties and entities doing business with the Commission must obtain a unique identifying number called the FCC Registration Number (FRN) and supply it when doing business with the Commission. Failure to provide the FRN may delay the processing of the application. This requirement is to facilitate compliance with the Debt Collection Improvement Act of 1996 (DCIA). The FRN can be obtained electronically through the FCC webpage at http://www.fcc.gov or by manually submitting FCC Form 160. FCC Form 160 is available from the FCC’s web site at http://www.fcc.gov/formpage.html, by calling the FCC’s Forms Distribution Center 1-800-418-FORM (3676), or from Federal Communications Commission Fax Information System by dialing (202) 418-0177. This notice is required by the Privacy Act of 1974, Public Law 93-579, December 31, 1974, 5 U.S.C. Section 552a(e)(3) and the Paperwork Reduction Act of 1995, Public Law 104-13, October 1, 1995, 44 U.S.C. 3507. FCC Form 602 – Instructions January 2007 – Page 1 American LegalNet, Inc. www.FormsWorkflow.com General Instructions Purpose of Form The purpose of FCC Form 602 is to collect ownership data pertaining to the filer for use by the FCC in determining whether the public interest would be served by a grant of the requested authorization. In doing so, the FCC uses FCC Form 602 to obtain information regarding the identity of the real party or parties in interest of the filer and to elicit additional information required by section 1.2112(a) of the Commission's Rules regarding: 1) persons or entities holding a 10% or greater direct or indirect ownership interest in the filer, see 47 C.F.R. § 1.2112(a)(1); 2) all limited partners whose interest in the filer is 10% or greater, see 47 C.F.R. § 1.2112(a)(2); 3) all general partners in any general partnership in the filer's chain of ownership, see 47 C.F.R. § 1.2112(a)(3); and 4) the members of any limited liability corporation whose interest in the filer is 10% or greater, see 47 C.F.R. § 1.2112(a)(4). A "direct owner" is an individual or entity that holds an immediate interest in the filer. An "indirect owner" is an individual or entity that holds a 10% or greater interest in the filer as determined by successive multiplication as defined in section 1.2112(a)(5) through an intervening entity or entities in an ownership chain. See 47 C.F.R. § 1.2112(a)(5). For each direct and indirect owner, the filer must provide all FCC-regulated entities or applicants for an FCC license in which the direct or indirect owner has a 10% or greater direct or indirect ownership interest as determined by successive multiplication. Example: In the following example Company A is the filer. Company A's stock is owned by two persons: Mary Smith owns 40% of the outstanding stock and Company B owns 60% of the outstanding stock. Each of these persons is a direct owner and a separate FCC Form 602, Schedule A would be filled out for each. Company B is in turn owned by John and Jane Doe, 50%, and by Mega Corporation, 50%. John and Jane Doe and Mega Corporation are indirect owners of the filer. An FCC Form 602, Schedule A would be separately filled out for John Doe, Jane Doe and Mega Corporation. Mega Corporation is in turn owned by Richard Mega, who holds 91% of the outstanding stock, as determined by successive multiplication, and Peter Smith, who holds 9% of the outstanding stock. Because Richard Mega indirectly owns more than 10% of Company A, information regarding Richard Mega would be provided on a FCC Form 602, Schedule A. However, because Peter Smith's indirect ownership share of Company A, when calculated using successive multiplication, is less than 10%, the filer would not be required to provide information regarding Peter Smith. Information Current and Complete During the pendency of the above mentioned applications, information contained in FCC Form 602 on file with the FCC must be kept current and complete. Pursuant to section 1.65 of the Commission’s Rules the applicant must notify the FCC regarding any substantial and significant changes in the information furnished in the FCC Form 602 or underlying application(s). See 47 C.F.R. § 1.65. Applicable Rules and Regulations Filers should obtain the relevant parts of the FCC's rules in Title 47 of the Code of Federal Regulations (47 CFR). Copies of 47 CFR may be purchased from the Superintendent of Documents, Government Printing Office, Washington, D.C. 20402, (202) 512-1800. Copies of 47 CFR may also be obtained, free of charge, from the Government Printing Office's Website at http://www.access.gpo.gov. Some FCC rules require applicants to attach one or more exhibits to an application in addition to the information requested in the application form. Processing Fee and Filing Locations No processing fee is required with the filing of FCC Form 602 separate and a part from any applicable filing fees for the associated application for authorization. For Assistance For assistance with FCC Form 602 call FCC Support Center at (877) 480-3201 (TTY 717-338-2824). Hours are from 8 a.m. to 7:00 p.m. Eastern Time, Monday through Friday (except Federal holidays). To provide quality service and ensure security, all telephone calls are recorded. Electronic Filers For technical assistance with filing electronically, you may visit the web at http://esupport.fcc.gov. You may also call FCC Support Center at (877) 4803201 (TTY 717-338-2824). Hours are from 8 a.m. to 7:00 p.m. Eastern Time, Monday through Friday (except Federal holidays). To provide quality service and ensure security, all telephone calls are recorded. FCC Form 602 – Instructions January 2007 – Page 2 American LegalNet, Inc. www.FormsWorkflow.com INSTRUCTIONS FOR FCC FORM 602, MAIN FORM Filer Information Item 1a & 1b Specify filing type in Item 1a. In Item 1b, indicate if the proposed filing is to report cellular cross-ownership holdings pursuant to Section 1.919 of the Commission’s Rules. If ‘Yes’, provide an exhibit that identifies the Rural Service Area market(s) involved, as well as the cellular licensee of which the filer has acquired direct or indirect ownership interest of 10% or greater. Items 2 and 3 These Items identify the filer. If the filer is an individual, enter the name of the individual in Item 1. If the filer is an entity, enter the name of the entity in Item 3. Item 4 Enter the filer’s ten-digit FCC Registration Number (FRN) assigned by the Commission Registration System (CORES). The FRN is a unique entity identifier for everyone doing business with the Commission. The FRN can be obtained electronically through the FCC website at http://www.fcc.gov (click FCC Registration Number (FRN) Commission Registration System (CORES)) or manually by submitting FCC Form 160. FCC Form 160 is available for downloading from http://www.fcc.gov/formpage.html or by calling 1-800-418-FORM (3676). Item 5 Enter the name, address, and telephone number of the person to whom the FCC should send correspondence. Enter the fax number and e-mail address, if available. Related FCC-Regulated Businesses of Filer List any FCC-regulated businesses in which the Filer holds 10% or more of the equity. Item 6(a) Identify the entity name. Item 6(b) Identify the principal nature of the FCC-regulated business. Item 6(c) Enter the ten-digit FCC Registration Number (FRN) assigned by the Commission Registration System (CORES). The FRN is a unique entity identifier for everyone doing business with the Commission. The FRN can be obtained electronically through the FCC webpage at http://www.fcc.gov (click FCC Registration Number (FRN) Commission Registration System (CORES)) or by manually submitting FCC Form 160. FCC Form 160 is available for downloading from http://www.fcc.gov/formpage.html or by calling 1-800-418-FORM (3676). Item 6(d) Identify the percentage of interest held in the FCC-regulated business by the filer. Signature Item 7 This information must be completed and signed in accordance with Part 1 of the Commission’s Rules, which requires, inter alia that the signor be authorized to sign on behalf of the filer. Paper originals must bear an original signature. Neither rubber-stamped nor photocopied signatures are acceptable on paper originals. FCC Form 602 – Instructions January 2007 – Page 3 American LegalNet, Inc. www.FormsWorkflow.com Appendix I STATE TABLE Abbreviations for States, Jurisdictions, and Areas AL AK AZ AR CA CO CT DE DC FL GA GM HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Gulf of Mexico Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming AS GU MP PW PR UM American Samoa Guam Northern Mariana Islands Palau Puerto Rico U.S. Territories: (Baker Island, Howland Island, Jarvis Island, Johston Atoll, Kingman Reef, Midway Island, Navassa Island, Palmyra Atoll and Wake Island) Virgin Islands VI AA AE AP Armed Forces-Americas (excluding Canada) Armed Forces-(Europe, Middle East, Africa, Canada) Armed Forces-Pacific FCC Form 602 – Instructions January 2007 – Page 4 American LegalNet, Inc. www.FormsWorkflow.com Instructions for FCC Form 602, Schedule A Disclosable Interest Holders in Filer (repeat for each disclosable interest holder) Pursuant to section 1.2112 of the Commission’s Rules, these items provide required information about the real party or parties in interest and other disclosable interest holders in the filer. If the filer has multiple disclosable interest holders, FCC Form 602, Schedule A must be filled out separately for each disclosable interest holder. Examples of disclosable interest holders include: (1) Any party holding a 10% or greater interest in the filer, whether direct or indirect. An indirect ownership interest in the filer is established where successive multiplication of ownership percentages for each link in the vertical ownership chain equals 10% or more of the filer, except that if the ownership percentage for an interest in any link in the chain exceeds 50 percent or represents actual control, it shall be treated and reported as if it were a 100% interest. (2) Any party holding 10% or more of any class of stock, warrants, options, or debt securities of the filer. (3) Any party with a controlling interest in the filer as set forth in section 1.2110 of the Commission's Rules. The individual or entity with a controlling interest is an "affiliate”. An affiliate is defined by Section 1.2110(b)(5) of the Commission's Rules, which provides that an individual or entity is an affiliate of a filer or of a person holding an attributable interest in a filer if such individual or entity: (A) directly or indirectly controls or has the power to control the filer, or (B) is directly or indirectly controlled by the filer, or (C) is directly or indirectly controlled by a third party or parties that also controls or has the power to control the filer, or (D) has an "identity of interest" with the filer. Section 1.2110(b)(5) states that every business concern is considered to have one or more parties who directly or indirectly control or have the power to control it. Control may be affirmative or negative and it is immaterial whether it is exercised so long as the power to control exists. (4) In the case of a general partnership, each general partner, regardless of percentage of interest in the filer. (5) In the case of a limited partnership, each limited partner whose direct or indirect interest in the filer is equal to or greater than 10% (as calculated according to the percentage or equity paid in and the percentage of distribution of profits and losses). (6) In the case of a limited liability company, each member of the company, whose direct or indirect interest in the filer is equal to or greater than 10%. For each disclosable interest holder, the following information must be provided: Items 1 and 2 These Items identify the interest holder. If the interest holder is an individual, enter the name of the individual in Item 1. If the interest holder is an entity, enter the name of the entity in Item 2. Item 3 Enter the ten-digit FCC Registration Number (FRN) assigned by the Commission Registration System (CORES). The FRN is a unique entity identifier for everyone doing business with the Commission. The FRN can be obtained electronically through the FCC website at http://www.fcc.gov (click FCC Registration Number (FRN) Commission Registration System (CORES)) or by manually submitting FCC Form 160. FCC Form 160 is available for downloading from http://www.fcc.gov/formpage.html or by calling 1-800-418-FORM (3676). Item 4 Address of the interest holder. Item 5 This item indicates the Type of interest in filer. Select which of the following categories describes the interest holder's interest in the filer. If more than one category applies, select each applicable category: Direct ownership interest in filer, Director, Indirect ownership interest in filer, Key management personnel, Management contract, Officer, or Other (If Other is selected, specify type of interest). Note: If the interest holder holds an indirect ownership interest in the filer, attach an exhibit explaining the ownership relationship from the indirect interest holder to the filer. Example for Indirect Ownership Interest: In the example provided in the section “Purpose of Form”, John and Jane Doe would each provide an exhibit listing Company B, through which they hold their interest in Company A, the filer. Richard Mega would provide an exhibit first listing Company B and then Mega Corporation, through which he holds an interest in Company A, the filer. Mary Smith would not be required to provide an exhibit because she holds a direct ownership interest in Company A, the filer. FCC Form 602 – Instructions January 2007 – Page 5 American LegalNet, Inc. www.FormsWorkflow.com Item 6 This item indicates the legal entity type of the applicant. Select either Individual, Corporation, Unincorporated Association, Trust, Government Entity, Consortium, General Partnership, Limited Liability Company, Limited Liability Partnership, Limited Partnership, or Other. When selecting ‘Other’, provide a description of the legal entity. Item 7 Percentage of interest held in filer. Where the interest holder holds an ownership interest in the filer, whether direct or indirect, identify the ownership percentage. Indirect interests should be calculated using a multiplier only in compliance with Section 1.2112(a)(5) of the Commission's Rules. Item 8 Type of ownership interest in filer. Where the interest holder holds an ownership interest in the filer, whether direct or indirect, identify, select the type of ownership interest. If more than one category applies, indicate each applicable category. Also indicate, if applicable, the information listed below for each type of ownership interest. Common stock – voting and/or non-voting, General Partnership shares – managing or non-managing, Limited Partnership shares – insulated or non-insulated, Membership shares, Option to acquire equity, Proprietorship, Preferred stock – voting and/or non-voting and convertible and/or or non-convertible, Warrant, or Other (If Other is selected, specify the type of ownership interest). Example: In the example provided in the section "Purpose of Form", each of the persons in the chain of ownership of Company A, the filer, would list "common stock" as their type of ownership interest. Item 9 Identify the interest holder's country of citizenship or jurisdiction of formation. jurisdiction. For example, United States not U.S. should be provided. Provide the complete name of the appropriate country or Related FCC-Regulated Businesses of Disclosable Interest Holders (repeat for each interest holder identified) Item 10 For each real party in interest or disclosable interest holder of the filer identified in Items 1 or 2 of FCC Form 602, Schedule A, list any FCCregulated business 10% or more of whose stock, warrants, options, or debt securities are owned by such person or entity. Item 10(a) Identify the entity name and address. Item 10(b) Identify the principal nature of the FCC-regulated business. Item 10(c) Enter the ten-digit FCC Registration Number (FRN) assigned by the Commission Registration System (CORES). The FRN is a unique entity identifier for everyone doing business with the Commission. The FRN can be obtained electronically through the FCC website at http://www.fcc.gov or by manually submitting FCC Form 160. FCC Form 160 is available for downloading from http://www.fcc.gov/formpage.html or by calling 1-800-418FORM (3676). Item 10(d) Identify the percentage of interest held in the FCC-regulated business by the person or entity identified in Item 1 or 2 of FCC Form 602, Schedule A. FCC Form 602 – Instructions January 2007 – Page 6 American LegalNet, Inc. www.FormsWorkflow.com FCC Form 602 Main Form FCC Ownership Disclosure Information for the Wireless Telecommunications Services Approved by OMB 3060 – 0799 See instructions for Public burden estimate Filing Type 1a) □ Current Filing □ Proposed Filing 1b) Is the purpose of this filing to report cellular cross-ownership holdings required pursuant to section 1.919 of the Commission’s Rules? □Yes □No If ‘Yes’, provide an exhibit with this filing that identifies the Rural Service Area market(s) involved, as well as the cellular licensee of which the filer has acquired direct or indirect ownership interest of 10% or greater. Filer Information 2) First Name (if individual): MI: Last Name: 3) Filer Name (if entity): Suffix: 4) FCC Registration Number (FRN): 5) Contact Information Name and Address: Telephone Number: ( Fax Number: ( ) E-mail Address: Attn: Related FCC Regulated Businesses of Filer 6a) Name of all FCC-Regulated Businesses owned by Filer (use additional sheets, if necessary): ) 6b) Principal Business: 6c) FCC Registration Number (FRN): 6d) Percent of Interest Held: Signature 7) Typed or Printed Name of Party Authorized to Sign First Name: MI: Last Name: Suffix: Title: Signature: Date: WILLFUL FALSE STATEMENTS MADE ON THIS FORM OR ANY ATTACHMENTS 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). FCC Form 602 Main Form January 2007 – Page 1 American LegalNet, Inc. www.FormsWorkflow.com FCC Form 602 Schedule A FCC Ownership Disclosure Information for the Wireless Telecommunications Services Approved by OMB 3060 – 0799 See instructions for Public burden estimate Schedule for Disclosable Interest Holders Disclosable Interest Holder Information (complete as many as required to describe all disclosable interest holders) 1) Disclosable Interest Holder’s First Name (if individual): 2) Disclosable Interest Holder’s Name (if entity): MI: Last Name: Suffix: 3) FCC Registration Number(FRN): 4) Disclosable Interest Holder’s Address: 5) Type of Interest in Filer 6) Disclosable Interest Holder is a (n): (Select One ) (Select One) □Direct ownership interest in filer □Director □Indirect ownership interest in filer □Key management personnel □Management contract □Officer □Other (Description of Type of Interest)_______________________ _____________________________ □Individual □Corporation □ Unincorporated Association □Trust □ Government Entity □Consortium □General Partnership □ Limited Liability Company □Limited Liability Partnership □Limited Partnership □Other (Description of Legal Entity) 7) Percent of Interest Held in Filer: _________________________________________________________ _________________________________________________________ 8) Disclosable Interest Holder’s Type of Ownership □Common stock – voting and/or non-voting □Option to acquire equity □Membership shares □Proprietorship □General Partnership shares – managing or non-managing □Limited Partnership shares – insulated or non-insulated □Warrant □Preferred stock – voting and/or non-voting and convertible and/or or non-convertible □Other (If Other is selected, specify the type of ownership interest) 9) Disclosable Interest Holder’s Country of Citizenship or Jurisdiction of Formation: _____________________________________________________________________________________ Related FCC Regulated Businesses of Disclosable Interest Holders (repeat for each interest holder identified) 10a) 10b) 10c) Name and address of all FCC-Regulated Principal Business: FCC Registration Number (FRN): Businesses owned by the Disclosable Interest Holder listed in Item 1 or 2 (use additional sheets, if necessary): 10d) Percent of Interest Held: FCC Form 602 Schedule A January 2007 – Page 1 American LegalNet, Inc. www.FormsWorkflow.com