Federal Communications Commission | Approved by OMB |
1270 Fairfield Road | |
Gettysburg PA | Estimated public |
TEMPORARY PERMIT TO OPERATE A | burden is 6 minutes |
GENERAL MOBILE RADIO SERVICE SYSTEM |
|
Public reporting burden for this collection of information is estimated to average six minutes per response, including the time for revie instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the colle of information. Send comments regarding this burden estimate, or any other aspect of this collection of information, inclu suggestions for reducing the burden to Federal Communications Commission,
λUse this form only if you want a Temporary Permit in the General Mobile Radio Service to share
1 processed by the Federal Communications Commission.
λDo not use this formif youoperate an individual,
λDo not use this form for any radio service other than the General Mobile Radio Service.
λDo not use this form unless you are anindividual. Partnerships, associations, corporations, and governmental entites are not eligible for a license in the General Mobile Radio Service.
I hereby certify that:
λI am not a foreign government or a representative thereof.
2λ I am eligible in the General Mobile Radio Service under Rule Section 95.5.
CERTIFICATION λ I have not been denied a license or had my license revoked by the FCC.
λI am not the subject of any other legal action concerning the operation of a radio station.
λ My completed Form 574 has been mailed to the FCC.
Name of Applicant | Date Form 574 Mailed to FCC |
Mailing Address ofApplicant (Number, Street, City, State, ZIPCode)