Uniden LTD 950 manual CERTIFICATION, Read Carefully Before Signing

Approved by OMS -

3060-0096

Expires 07/31/93

FEDERALCOMMUNICATIONSCOMMISSIONSee page two for information regarding public burden estimate.

Application for Ship Radio Station License

D D

A.CHECK BLOCK "A" ONLY IF SHIP IS RECREATIONAL OR VOLUNTARILY EQUIPPED. Complete applicable items 1 thru 13and sign application. You will automatically be authorized for VHF (156-158 MHz) & Class C EPIRB (156.75-156.8 MHz). Additional equipment other than VHF & EPIRB must be requested in Item 16.

B.CHECK BLOCK "B" ONLY IF SHIP IS COMPULSORY EQUIPPED (REQUIRED TO BE RADIO EQUIPPED). Complete applicable

items I thru 18 and sign application. You will only be authorized for the specific category of transmitters that you have checked in Item 16. (See

instruction 16) '.

1. Type of Applicant	(Ckleck only one)	(A) Association	I 14. Ship	adioRequirementCategories(Seeinstruction)				,
D (I) Individual		. (P) Partnership		D	(A)	Radiotelegraph	Station Required by Title	Ill, Part 11ofthe
						Communications	Act or Safety of Life at Sea Convention.
D (C) Corporation		§ (G) Governmental Entity		D	(B)	Radiotelephone	Station Required by Title	Ill, Part 11of the
						Communications	Act or Safety of Life at Sea Convention,
2. ApplicanVLicensee Name (See instruction)				D (C) Radiotelephon~			Station Required by Title	Ill, Part III of the
				0 (D)		Communications	A~t.
DBAName (See instruction)						Radiotelephone	Station Required by the Great Lakes Radio
				,		Agreement.
3. MailingAddress	(Number and Street, P.O. Box or Rt. No.)			D (E)		Radiotelephone	Station Required by the Vessel Bridge- To-
						BridgeRadiotelephoneAct.

15. Gross Tonnage and/or Len!;}th of Ship (See instruction)

City State ZIP Code

4.Additional Partners

5.Purpose of Application

D New Station D Modification D Renewal

6. Type of License{Check o~one)

D (R) Regular U (F) Fleet (No. of ships) -

D (P) Portable (Give required showing)

7.Name of Ship (See instruction)

8.Official Number of Ship (Coast Guard Documentation No. or State Registration No.): If none, see instruction.

9.Call Sign (See inst.ruction)

10. Class of Ship (See instruction)
(~) General:	(B) Specific:

11.Relationship of Applicant to Ship (Check only one) D (A) Owner and/or Operator

D (B-)Other (Specify)

12. International Communications: (See instruction) YES NO

(A) Gross Tons: (B) Feet:

16.Category of Transmitters (See instruction}

Check No. (Categories)

VHF/FM Radiotelephone(I 56-158MHz)& EPIRB(156.75-156.8MHz) EPIRB (121.5and/or 243 MHz) ClassA,B. or S

SSB Radiotelephone(1600-4000kHz)

SSB Radiotelephone(4000-23000kHz)

Radar (2900-3100MHz) and;or (9300-9500MHz)

Radar (14.0-14.05GHz)

Radiotelegraph(2000-27500kHz) Except Direct Printing

Radiotelegraph(2000-27500kHz) Direct Printing (NBDP/SITOR)

Radiotelegraph(405-535kHz)

Survival Craft (500 kHz) (8364kHz)

RTTY-Radioprinter (Under 1600GrossTons)

AMTS (216-220MHz)

Facsimile

Satellite (16365-1644MHz)

EPIRB (1645.5-1646.5MHz)

EPIRB (406-406.1MHz)

On-Board (457.525-467.825MHz)

OTHER (Seeinstruction)

(A)Will Ship make international voyages?

(B)Will Ship communicate with foreign coast sta- tions other than those located in Canada or Mexico?

13.(A) Are you requesting a Ship Station Identity (9 digit number) to be used with Digital Selective Calling Equipment?

(B)Have you been assigned a Ship Station Iden-

tity Number for,this Ship? If YES, show number

DD 17. Radiotelegraph Morse Working Channel Series

D	D	(2000-27500	kHz):
				W_-,W_-
YES	NO
D	D	18. Numerical ShipcStation Identification
D	D	(A) Selective	Call .	(B) INMARSAT
		Number	(5 digits)	Number (7 digits)

CERTIFICATION, READ CAREFULLY BEFORE SIGNING

1.Applicant waives any claim to the use of any particular frequency regardless of prior use by license or otherwise.

2.Applicant will have unlimited access to the radio equipment and willcontrol access to exclude unauthorized persons.

3. Neither applicant nor any member thereof is a foreign government or representative thereof. .

4.Applicant certifies that all statements made in this application and attachments are true, complete, correct and made in good faith.

5.Applicant certifies that the signature is that of the individual, or partner, or officer or duly authorized employee of a corporation,or officer who is a member of an unincorporated association, or appropriate elected or appointed official on behalf of a governmental er:'tity.

WILLFULFALSESTATEMENTSMADEONTHISFORMAREPUNISHABLEBYFINEAND/ORIMPRISONMENTU.S. .CODETITLE18,SECTION1001

Typed/Printed Signor Name:	Telephone No:
Signature:	Date:

FCC Form 506, Page 1

February 1991