FCC 605 Schedule D FEDERAL COMMUNICATIONS COMMISSION Information and Instructions Instructions for Schedule for Additional Data in the Amateur Radio Service Approved by OMB 3060 - 0850 See 605 Main Form Instructions for public burden estimate Form FCC 605, Schedule D, is a supplementary schedule for use with the FCC Quick-Form Application for Authorization in the Ship, Aircraft, Amateur, Restricted and Commercial Operator, and the General Mobile Radio Services, FCC 605 Main Form. This schedule is used to apply for the required license authorization in the Amateur Radio Service. This schedule is used to apply for a call sign change or to apply for a vanity call sign. The FCC 605 Main Form must be filed in conjunction with this schedule. Schedule D Instructions Amateur Station Call Sign Change and Vanity Call Sign Request Information Item 1 If this is a request to change your call sign to the next systematically assigned call sign you are eligible for, enter `Y'. This will result in your call sign being selected by the FCC from an alphabetized list corresponding to the geographic region of your mailing address and operator class. If this is to request a Vanity call sign, enter `N'. If this is a Modification or Renew/Modification application with NO change in call sign requested, enter `N' and skip Items 2 and 3. Item 2 If this is a request to apply for a vanity call sign, place an 'X' in the appropriate box and enter the additional information requested. (Only one block may be checked) Item 3 Preference List: Give the exact prefix, numeral and suffix of each call sign that you wish to include in your preference list for vanity call sign assignment. NOTE: If none of the call signs that you request are assignable, you will retain your existing call sign. FCC 605 Schedule D - Instructions April 2014 - Page 1 American LegalNet, Inc. www.FormsWorkFlow.com FCC 605 Schedule D Schedule for Additional Data in the Amateur Radio Service Approved by OMB 3060 - 0850 See 605 Main Form Instructions for public burden estimate AMATEUR STATION CALL SIGN CHANGE AND VANITY CALL SIGN REQUEST Systematic Call Sign Change 1) Is this a request to change your station call sign to the next systematically available call sign? ( ) Yes No If you answered Yes (`Y') to Item 1, do not complete Items 2 and 3 on this schedule. If completing Item 2, Item 1 must be answered No (`N'). Vanity Call Sign Change 2) I hereby apply for a vanity call sign under the following eligibility: (make an `X' in the appropriate box and enter the required information): (Only 1 block may be checked) A) FORMER PRIMARY STATION HOLDER: I request call sign _______________ be shown on my primary station license. By checking this box, I certify that the call sign being requested was previously assigned to my station and that I can provide documentation, if requested. B) CLOSE RELATIVE OF FORMER HOLDER: I request call sign _______________ be shown on my primary station license. By checking this box, I certify that the call sign being requested was shown on the primary station license of my deceased spouse, child, grandchild, stepchild, parent, grandparent, stepparent, brother, sister, stepbrother, stepsister, aunt, uncle, niece, nephew, or in-law within the past 2 years and that I can provide documentation, if requested. Enter the deceased relationship to you: ____________________________________. FORMER CLUB STATION HOLDER: I request call sign _______________ be shown on the license for the club station, for which I am the license trustee. By checking this box, I certify that the call sign being requested was shown on the license for this club station within the past 2 years and that I can provide documentation, if requested. CLUB STATION WITH CONSENT OF FORMER HOLDER OR CLOSE RELATIVE OF FORMER HOLDER: I request that the call sign _______________ be shown on the license for the club station, for which I am the license trustee. By checking this box, I certify that the call sign being requested was shown on the primary station license of a person now deceased within the past 2 years. I also certify that I am acting with written consent of the former holder now deceased or of the deceased former holder's spouse, child, grandchild, stepchild, parent, grandparent, stepparent, brother, sister, stepbrother, stepsister, aunt, uncle, niece, nephew, or in-law, and I can provide documentation of that consent, if requested. Enter "self" if deceased licensee gave consent or the relationship of the person giving consent: ____________________________________________. PRIMARY STATION PREFERENCE LIST: I request the first assignable call sign from my preference list in item #3 be shown on the license for my primary station. CLUB STATION PREFERENCE LIST: I request the first assignable call sign from my preference list in item #3 be shown on the license for the club station, for which I am the license trustee. C) D) E) F) Vanity Call Sign PREFERENCE LIST 3) Select your preference list of vanity call signs very carefully. Give exact prefix, numeral, and suffix for each call sign. 1) 2) 3) 4) 5) 6) 7) 8) 9) 10) 11) 12) 13) 14) 15) 16) 17) 18) 19) 20) 21) 22) 23) 24) 25) Note: If none of the call signs you selected are assignable, you will retain your existing call sign. FCC 605 - Schedule D April 2014 - Page 1 American LegalNet, Inc. www.FormsWorkFlow.com