Federal Communications Commission
Washington, D.C. 20554
Approved by OMB
3060-0010 (June 2014)
FOR FCC USE ONLY
 

FCC 323
OWNERSHIP REPORT FOR COMMERCIAL BROADCAST STATIONS

FOR COMMISSION USE ONLY
FILE NO. BOA-20151112PAV

Section I - General Information
1. Legal Name of the Respondent
IHEARTMEDIA CAPITAL I, LLC
Street Address (1)
2625 S. MEMORIAL DRIVE
Street Address (2)
SUITE A
City
TULSA
State or Country (if foreign address)
OK

ZIP Code
74129 -

Telephone Number (include area code)
9186644581
E-Mail Address (if available) 
FCC Registration Number:
0019970490
Call Sign 
KOY
Facility ID Number 
63914
2. Contact Representative
KATHLEEN A. KIRBY
Firm or Company Name
WILEY REIN LLP
Street Address (1)
1776 K STREET, NW
Street Address (2)
City
WASHINGTON
State or Country (if foreign address)
DC
ZIP Code
20006 -
Telephone Number (include area code)
2027193360
E-Mail Address (if available)
KKIRBY@WILEYREIN.COM
3. Nature of Respondent (See Instructions for definitions)
radio button not selected Licensee
radio button not selected Permittee
radio button selected Entity with an attributable interest
4. If this application has been submitted without a fee, indicate reason for fee exemption (see 47 C.F.R. Section 1.1114):
radio button not selectedGovernmental Entity radio button selected radio button not selectedOther Other radio button not selected N/A (Fee Required)
5. All of the information furnished in this Report is accurate as of 10/01/2015
(Date entered must (1) be Oct. 1 of the filing year when filing a Biennial Ownership Report (or Nov. 1, 2009 in the case of the initial filing); or (2) be no more than 60 days prior to the date of filing when filing a non-biennial Ownership Report.)
6. Purpose: This Report is filed for: (choose one)
a. radio button selected Biennial
b. radio button not selected Validation and Resubmission of a previously filed Biennial Report (certifying no change from previous Report)
c. radio button not selected Transfer of Control or Assignment of License/Permit
d. radio button not selected Report by Permittee filing within 30 days after the grant of a construction permit for a new commercial AM, FM or full power television broadcast station.
e. radio button not selected Update / certification of accuracy of an initial Ownership Report filed by Permittee (filing in conjunction with Permittee's application for a station license)
f. radio button not selected Amendment to a previously filed Ownership Report
File Number: -
If an Amendment, submit as an Exhibit a listing by Section and Question Number the portions of the previous Report that are being revised.
7. Licensee and Station Information. The stations listed below are all licensed to the following person or entity:
Licensee Name Licensee's FCC Registration Number (FRN)
AMFM RADIO LICENSES, LLC
0001656586
FRN Help: CORES Home

Station List

This Report is filed for the following stations:
Copy Call Sign Facility ID Number Location (City/State) Class of service Delete Copy
1. , IOWA AM Station
2. , IOWA AM Station
3. , WEST VIRGINIA AM Station
4. , CALIFORNIA AM Station
5. , GEORGIA AM Station
6. , MASSACHUSETTS AM Station
7. , PENNSYLVANIA AM Station
8. , MICHIGAN AM Station
9. , ARIZONA AM Station
10. , ARIZONA AM Station
11. , ARIZONA AM Station
12. , NEW YORK AM Station
13. , PENNSYLVANIA AM Station
14. , GEORGIA AM Station
15. , NEW YORK FM Station
16. , MICHIGAN FM Station
17. , MICHIGAN FM Station
18. , NEW YORK FM Station
19. , DISTRICT OF COLUMBIA FM Station
20. , IOWA FM Station
21. , NEBRASKA FM Station
22. , IOWA FM Station
23. , ARIZONA FM Station
24. , PENNSYLVANIA FM Station
25. , PENNSYLVANIA FM Station
26. , NEW YORK FM Station
27. , DISTRICT OF COLUMBIA FM Station
28. , VIRGINIA FM Station
29. , MICHIGAN FM Station
30. , MICHIGAN FM Station
31. , NEW JERSEY FM Station
32. , PENNSYLVANIA FM Station
33. , GEORGIA FM Station
34. , GEORGIA FM Station
35. , GEORGIA FM Station
36. , NEW YORK FM Station
37. , DISTRICT OF COLUMBIA FM Station
38. , PENNSYLVANIA FM Station
39. , DISTRICT OF COLUMBIA FM Station
40. , GEORGIA FM Station
41. , FLORIDA FM Station
42. , NEW YORK FM Station
43. , MASSACHUSETTS FM Station
44. , PENNSYLVANIA FM Station
45. , MASSACHUSETTS FM Station
46. , PENNSYLVANIA FM Station
47. , DISTRICT OF COLUMBIA FM Station
48. , NEW YORK FM Station
49. , MICHIGAN FM Station
50. , MASSACHUSETTS FM Station
51. , NEW YORK AM Station
52. , MASSACHUSETTS FM Station
53. , MASSACHUSETTS FM Station
54. , MASSACHUSETTS FM Station
55. , MASSACHUSETTS FM Station
56. , SOUTH CAROLINA FM Station
57. , SOUTH CAROLINA FM Station
58. , SOUTH CAROLINA FM Station
59. , NORTH CAROLINA FM Station
60. , NORTH CAROLINA FM Station
61. , SOUTH CAROLINA FM Station
62. , SOUTH CAROLINA FM Station
63. , SOUTH CAROLINA FM Station
64. , SOUTH CAROLINA AM Station
65. , SOUTH CAROLINA FM Station
66. , SOUTH CAROLINA FM Station
67. , SOUTH CAROLINA FM Station
68. , SOUTH CAROLINA AM Station
69. , ALABAMA FM Station
70. , ALABAMA AM Station
71. , ALABAMA FM Station
72. , ALABAMA AM Station
73. , GEORGIA FM Station
74. , GEORGIA AM Station
75. , GEORGIA FM Station
76. , GEORGIA FM Station
77. , GEORGIA AM Station
78. , GEORGIA AM Station
79. , GEORGIA FM Station

(Check/Uncheck All)
 
8. Respondent is:
radio button not selected Sole Proprietorship radio button not selected Not-for-profit corporation radio button not selected Limited partnership
radio button not selected For-profit corporation radio button not selected General partnership radio button selected Other
If "Other," describe nature of the Respondent in an Exhibit.  
 
 

Section II-B - Biennial Ownership Information

1. Contract Information. List all contracts and other instruments required to be filed by 47 C.F.R. Section 73.3613. (Only Licensees, or Respondents with a majority interest in or that otherwise exercise de facto control over the subject Licensee shall respond. Other Respondents should select "Not Applicable" in response to this question.) If the agreement is a local marketing agreement (LMA) or a joint sales agreement (JSA), or if the agreement is a network affiliation agreement, check the appropriate box; otherwise, select "Other" for non-LMA/JSA or network affiliation agreements.
checkbox checked Not Applicable

Contract Information

   



2. Capitalization (Only Licensees or entities with a majority interest in or that otherwise exercises de facto control over the subject Licensee shall respond.)
checkbox checked Not Applicable

Capitalization Information


(Check/
Uncheck All)
 
3. (a.) Ownership Interests. This Question requires Respondents to enter detailed information about ownership interests by generating a series of subforms. Answer each question on each subform. The first subform listing should be for the Respondent itself. If the Respondent is not a natural person, also list each of the officers, directors, stockholders, noninsulated partners, members and other persons or entities with a direct attributable interest in the Respondent. (A "direct" interest is one that is not held through any intervening companies or entities.) In the case of vertical or indirect ownership structures, report only those interests in the Respondent that also represent an attributable interest in the Licensee for which the Report is being submitted.

List each person or entity with a direct attributable interest in the Respondent separately. Entities that are part of an organizational structure that includes holding companies or other forms of indirect ownership must file separate ownership reports. In such a structure do not report or file separate reports for persons or entities that do not have an attributable interest in the Licensee for which the report is being submitted.

Ownership Interests Information

Copy 1. Name  
Address Street


City/State
, OKLAHOMA
Postal/ZIP Code
-
Country (if not U.S.)
Listing Type radio button selected Respondent
radio button not selected Other Interest Holder
Relationship to Licensee radio button not selected Licensee (or Officer/Director of Licensee)
radio button not selected Person with attributable interest
radio button selected Entity with attributable interest
Positional Interest
(Check all that apply)

checkbox not checked Officer
checkbox not checked Director
checkbox not checked General Partner
checkbox not checked Limited Partner
checkbox not checked LC/LLC/PLLC Member
checkbox checked Owner
checkbox not checked Stockholder
checkbox not checked Attributable Creditor
checkbox not checked Attributable Investor
checkbox not checked Other (please specify):

FCC Registration Number
0019970490
  Gender, Ethnicity, Race and Citizenship Information
(Natural Persons)
checkbox checked N/A (entity)  
Gender
radio button not selected Male radio button not selected Female
Ethnicity
radio button not selected Hispanic or Latino
radio button not selected Not Hispanic or Latino
Race (Check all that apply)
checkbox not checked American Indian or Alaska Native
checkbox not checked Asian
checkbox not checked Black or African American
checkbox not checked Native Hawaiian or Other Pacific Islander
checkbox not checked White
Citizenship
  Percentage of votes %  
  Percentage of equity %  
  Percentage of total assets
(equity debt plus)
%  
Copy 2. Name  
Address Street


City/State
, OKLAHOMA
Postal/ZIP Code
-
Country (if not U.S.)
Listing Type radio button not selected Respondent
radio button selected Other Interest Holder
Relationship to Licensee radio button not selected Licensee (or Officer/Director of Licensee)
radio button not selected Person with attributable interest
radio button selected Entity with attributable interest
Positional Interest
(Check all that apply)

checkbox not checked Officer
checkbox not checked Director
checkbox not checked General Partner
checkbox not checked Limited Partner
checkbox checked LC/LLC/PLLC Member
checkbox not checked Owner
checkbox not checked Stockholder
checkbox not checked Attributable Creditor
checkbox not checked Attributable Investor
checkbox not checked Other (please specify):

FCC Registration Number
0019970425
  Gender, Ethnicity, Race and Citizenship Information
(Natural Persons)
checkbox checked N/A (entity)  
Gender
radio button not selected Male radio button not selected Female
Ethnicity
radio button not selected Hispanic or Latino
radio button not selected Not Hispanic or Latino
Race (Check all that apply)
checkbox not checked American Indian or Alaska Native
checkbox not checked Asian
checkbox not checked Black or African American
checkbox not checked Native Hawaiian or Other Pacific Islander
checkbox not checked White
Citizenship
  Percentage of votes %  
  Percentage of equity %  
  Percentage of total assets
(equity debt plus)
%  
Copy 3. Name  
Address Street


City/State
, OKLAHOMA
Postal/ZIP Code
-
Country (if not U.S.)
Listing Type radio button not selected Respondent
radio button selected Other Interest Holder
Relationship to Licensee radio button not selected Licensee (or Officer/Director of Licensee)
radio button selected Person with attributable interest
radio button not selected Entity with attributable interest
Positional Interest
(Check all that apply)

checkbox checked Officer
checkbox not checked Director
checkbox not checked General Partner
checkbox not checked Limited Partner
checkbox not checked LC/LLC/PLLC Member
checkbox not checked Owner
checkbox not checked Stockholder
checkbox not checked Attributable Creditor
checkbox not checked Attributable Investor
checkbox not checked Other (please specify):

FCC Registration Number
0024974388
  Gender, Ethnicity, Race and Citizenship Information
(Natural Persons)
checkbox not checked N/A (entity)  
Gender
radio button selected Male radio button not selected Female
Ethnicity
radio button not selected Hispanic or Latino
radio button selected Not Hispanic or Latino
Race (Check all that apply)
checkbox not checked American Indian or Alaska Native
checkbox not checked Asian
checkbox not checked Black or African American
checkbox not checked Native Hawaiian or Other Pacific Islander
checkbox checked White
Citizenship
  Percentage of votes %  
  Percentage of equity %  
  Percentage of total assets
(equity debt plus)
%  
Copy 4. Name  
Address Street


City/State
, OKLAHOMA
Postal/ZIP Code
-
Country (if not U.S.)
Listing Type radio button not selected Respondent
radio button selected Other Interest Holder
Relationship to Licensee radio button not selected Licensee (or Officer/Director of Licensee)
radio button selected Person with attributable interest
radio button not selected Entity with attributable interest
Positional Interest
(Check all that apply)

checkbox checked Officer
checkbox not checked Director
checkbox not checked General Partner
checkbox not checked Limited Partner
checkbox not checked LC/LLC/PLLC Member
checkbox not checked Owner
checkbox not checked Stockholder
checkbox not checked Attributable Creditor
checkbox not checked Attributable Investor
checkbox checked Other (please specify):

FCC Registration Number
0019850411
  Gender, Ethnicity, Race and Citizenship Information
(Natural Persons)
checkbox not checked N/A (entity)  
Gender
radio button selected Male radio button not selected Female
Ethnicity
radio button not selected Hispanic or Latino
radio button selected Not Hispanic or Latino
Race (Check all that apply)
checkbox not checked American Indian or Alaska Native
checkbox not checked Asian
checkbox not checked Black or African American
checkbox not checked Native Hawaiian or Other Pacific Islander
checkbox checked White
Citizenship
  Percentage of votes %  
  Percentage of equity %  
  Percentage of total assets
(equity debt plus)
%  
Copy 5. Name  
Address Street


City/State
, OKLAHOMA
Postal/ZIP Code
-
Country (if not U.S.)
Listing Type radio button not selected Respondent
radio button selected Other Interest Holder
Relationship to Licensee radio button not selected Licensee (or Officer/Director of Licensee)
radio button selected Person with attributable interest
radio button not selected Entity with attributable interest
Positional Interest
(Check all that apply)

checkbox checked Officer
checkbox not checked Director
checkbox not checked General Partner
checkbox not checked Limited Partner
checkbox not checked LC/LLC/PLLC Member
checkbox not checked Owner
checkbox not checked Stockholder
checkbox not checked Attributable Creditor
checkbox not checked Attributable Investor
checkbox not checked Other (please specify):

FCC Registration Number
0020270286
  Gender, Ethnicity, Race and Citizenship Information
(Natural Persons)
checkbox not checked N/A (entity)  
Gender
radio button selected Male radio button not selected Female
Ethnicity
radio button not selected Hispanic or Latino
radio button selected Not Hispanic or Latino
Race (Check all that apply)
checkbox not checked American Indian or Alaska Native
checkbox not checked Asian
checkbox not checked Black or African American
checkbox not checked Native Hawaiian or Other Pacific Islander
checkbox checked White
Citizenship
  Percentage of votes %  
  Percentage of equity %  
  Percentage of total assets
(equity debt plus)
%  
Copy 6. Name  
Address Street


City/State
, OKLAHOMA
Postal/ZIP Code
-
Country (if not U.S.)
Listing Type radio button not selected Respondent
radio button selected Other Interest Holder
Relationship to Licensee radio button not selected Licensee (or Officer/Director of Licensee)
radio button selected Person with attributable interest
radio button not selected Entity with attributable interest
Positional Interest
(Check all that apply)

checkbox checked Officer
checkbox not checked Director
checkbox not checked General Partner
checkbox not checked Limited Partner
checkbox not checked LC/LLC/PLLC Member
checkbox not checked Owner
checkbox not checked Stockholder
checkbox not checked Attributable Creditor
checkbox not checked Attributable Investor
checkbox not checked Other (please specify):

FCC Registration Number
0020289187
  Gender, Ethnicity, Race and Citizenship Information
(Natural Persons)
checkbox not checked N/A (entity)  
Gender
radio button selected Male radio button not selected Female
Ethnicity
radio button not selected Hispanic or Latino
radio button selected Not Hispanic or Latino
Race (Check all that apply)
checkbox not checked American Indian or Alaska Native
checkbox not checked Asian
checkbox not checked Black or African American
checkbox not checked Native Hawaiian or Other Pacific Islander
checkbox checked White
Citizenship
  Percentage of votes %  
  Percentage of equity %  
  Percentage of total assets
(equity debt plus)
%  
Copy 7. Name  
Address Street


City/State
, OKLAHOMA
Postal/ZIP Code
-
Country (if not U.S.)
Listing Type radio button not selected Respondent
radio button selected Other Interest Holder
Relationship to Licensee radio button not selected Licensee (or Officer/Director of Licensee)
radio button selected Person with attributable interest
radio button not selected Entity with attributable interest
Positional Interest
(Check all that apply)

checkbox checked Officer
checkbox not checked Director
checkbox not checked General Partner
checkbox not checked Limited Partner
checkbox not checked LC/LLC/PLLC Member
checkbox not checked Owner
checkbox not checked Stockholder
checkbox not checked Attributable Creditor
checkbox not checked Attributable Investor
checkbox not checked Other (please specify):

FCC Registration Number
0020090346
  Gender, Ethnicity, Race and Citizenship Information
(Natural Persons)
checkbox not checked N/A (entity)  
Gender
radio button selected Male radio button not selected Female
Ethnicity
radio button not selected Hispanic or Latino
radio button selected Not Hispanic or Latino
Race (Check all that apply)
checkbox not checked American Indian or Alaska Native
checkbox not checked Asian
checkbox not checked Black or African American
checkbox not checked Native Hawaiian or Other Pacific Islander
checkbox checked White
Citizenship
  Percentage of votes %  
  Percentage of equity %  
  Percentage of total assets
(equity debt plus)
%  
Copy 8. Name  
Address Street


City/State
, OKLAHOMA
Postal/ZIP Code
-
Country (if not U.S.)
Listing Type radio button not selected Respondent
radio button selected Other Interest Holder
Relationship to Licensee radio button not selected Licensee (or Officer/Director of Licensee)
radio button selected Person with attributable interest
radio button not selected Entity with attributable interest
Positional Interest
(Check all that apply)

checkbox checked Officer
checkbox not checked Director
checkbox not checked General Partner
checkbox not checked Limited Partner
checkbox not checked LC/LLC/PLLC Member
checkbox not checked Owner
checkbox not checked Stockholder
checkbox not checked Attributable Creditor
checkbox not checked Attributable Investor
checkbox not checked Other (please specify):

FCC Registration Number
0019415140
  Gender, Ethnicity, Race and Citizenship Information
(Natural Persons)
checkbox not checked N/A (entity)  
Gender
radio button not selected Male radio button selected Female
Ethnicity
radio button not selected Hispanic or Latino
radio button selected Not Hispanic or Latino
Race (Check all that apply)
checkbox not checked American Indian or Alaska Native
checkbox not checked Asian
checkbox not checked Black or African American
checkbox not checked Native Hawaiian or Other Pacific Islander
checkbox checked White
Citizenship
  Percentage of votes %  
  Percentage of equity %  
  Percentage of total assets
(equity debt plus)
%  
Copy 9. Name  
Address Street


City/State
, OKLAHOMA
Postal/ZIP Code
-
Country (if not U.S.)
Listing Type radio button not selected Respondent
radio button selected Other Interest Holder
Relationship to Licensee radio button not selected Licensee (or Officer/Director of Licensee)
radio button selected Person with attributable interest
radio button not selected Entity with attributable interest
Positional Interest
(Check all that apply)

checkbox checked Officer
checkbox not checked Director
checkbox not checked General Partner
checkbox not checked Limited Partner
checkbox not checked LC/LLC/PLLC Member
checkbox not checked Owner
checkbox not checked Stockholder
checkbox not checked Attributable Creditor
checkbox not checked Attributable Investor
checkbox not checked Other (please specify):

FCC Registration Number
0020270542
  Gender, Ethnicity, Race and Citizenship Information
(Natural Persons)
checkbox not checked N/A (entity)  
Gender
radio button selected Male radio button not selected Female
Ethnicity
radio button not selected Hispanic or Latino
radio button selected Not Hispanic or Latino
Race (Check all that apply)
checkbox not checked American Indian or Alaska Native
checkbox not checked Asian
checkbox not checked Black or African American
checkbox not checked Native Hawaiian or Other Pacific Islander
checkbox checked White
Citizenship
  Percentage of votes %  
  Percentage of equity %  
  Percentage of total assets
(equity debt plus)
%  
Copy 10. Name  
Address Street


City/State
, OKLAHOMA
Postal/ZIP Code
-
Country (if not U.S.)
Listing Type radio button not selected Respondent
radio button selected Other Interest Holder
Relationship to Licensee radio button not selected Licensee (or Officer/Director of Licensee)
radio button selected Person with attributable interest
radio button not selected Entity with attributable interest
Positional Interest
(Check all that apply)

checkbox checked Officer
checkbox not checked Director
checkbox not checked General Partner
checkbox not checked Limited Partner
checkbox not checked LC/LLC/PLLC Member
checkbox not checked Owner
checkbox not checked Stockholder
checkbox not checked Attributable Creditor
checkbox not checked Attributable Investor
checkbox not checked Other (please specify):

FCC Registration Number
0019415504
  Gender, Ethnicity, Race and Citizenship Information
(Natural Persons)
checkbox not checked N/A (entity)  
Gender
radio button selected Male radio button not selected Female
Ethnicity
radio button not selected Hispanic or Latino
radio button selected Not Hispanic or Latino
Race (Check all that apply)
checkbox not checked American Indian or Alaska Native
checkbox not checked Asian
checkbox not checked Black or African American
checkbox not checked Native Hawaiian or Other Pacific Islander
checkbox checked White
Citizenship
  Percentage of votes %  
  Percentage of equity %  
  Percentage of total assets
(equity debt plus)
%  
Copy 11. Name  
Address Street


City/State
, OKLAHOMA
Postal/ZIP Code
-
Country (if not U.S.)
Listing Type radio button not selected Respondent
radio button selected Other Interest Holder
Relationship to Licensee radio button not selected Licensee (or Officer/Director of Licensee)
radio button selected Person with attributable interest
radio button not selected Entity with attributable interest
Positional Interest
(Check all that apply)

checkbox checked Officer
checkbox not checked Director
checkbox not checked General Partner
checkbox not checked Limited Partner
checkbox not checked LC/LLC/PLLC Member
checkbox not checked Owner
checkbox not checked Stockholder
checkbox not checked Attributable Creditor
checkbox not checked Attributable Investor
checkbox not checked Other (please specify):

FCC Registration Number
0019415561
  Gender, Ethnicity, Race and Citizenship Information
(Natural Persons)
checkbox not checked N/A (entity)  
Gender
radio button selected Male radio button not selected Female
Ethnicity
radio button not selected Hispanic or Latino
radio button selected Not Hispanic or Latino
Race (Check all that apply)
checkbox not checked American Indian or Alaska Native
checkbox not checked Asian
checkbox not checked Black or African American
checkbox not checked Native Hawaiian or Other Pacific Islander
checkbox checked White
Citizenship
  Percentage of votes %  
  Percentage of equity %  
  Percentage of total assets
(equity debt plus)
%  
Copy 12. Name  
Address Street


City/State
, OKLAHOMA
Postal/ZIP Code
-
Country (if not U.S.)
Listing Type radio button not selected Respondent
radio button selected Other Interest Holder
Relationship to Licensee radio button not selected Licensee (or Officer/Director of Licensee)
radio button selected Person with attributable interest
radio button not selected Entity with attributable interest
Positional Interest
(Check all that apply)

checkbox checked Officer
checkbox not checked Director
checkbox not checked General Partner
checkbox not checked Limited Partner
checkbox not checked LC/LLC/PLLC Member
checkbox not checked Owner
checkbox not checked Stockholder
checkbox not checked Attributable Creditor
checkbox not checked Attributable Investor
checkbox not checked Other (please specify):

FCC Registration Number
0022544555
  Gender, Ethnicity, Race and Citizenship Information
(Natural Persons)
checkbox not checked N/A (entity)  
Gender
radio button not selected Male radio button selected Female
Ethnicity
radio button not selected Hispanic or Latino
radio button selected Not Hispanic or Latino
Race (Check all that apply)
checkbox not checked American Indian or Alaska Native
checkbox not checked Asian
checkbox not checked Black or African American
checkbox not checked Native Hawaiian or Other Pacific Islander
checkbox checked White
Citizenship
  Percentage of votes %  
  Percentage of equity %  
  Percentage of total assets
(equity debt plus)
%  
Copy 13. Name  
Address Street


City/State
, OKLAHOMA
Postal/ZIP Code
-
Country (if not U.S.)
Listing Type radio button not selected Respondent
radio button selected Other Interest Holder
Relationship to Licensee radio button not selected Licensee (or Officer/Director of Licensee)
radio button selected Person with attributable interest
radio button not selected Entity with attributable interest
Positional Interest
(Check all that apply)

checkbox checked Officer
checkbox not checked Director
checkbox not checked General Partner
checkbox not checked Limited Partner
checkbox not checked LC/LLC/PLLC Member
checkbox not checked Owner
checkbox not checked Stockholder
checkbox not checked Attributable Creditor
checkbox not checked Attributable Investor
checkbox not checked Other (please specify):

FCC Registration Number
0024058000
  Gender, Ethnicity, Race and Citizenship Information
(Natural Persons)
checkbox not checked N/A (entity)  
Gender
radio button not selected Male radio button selected Female
Ethnicity
radio button not selected Hispanic or Latino
radio button selected Not Hispanic or Latino
Race (Check all that apply)
checkbox not checked American Indian or Alaska Native
checkbox not checked Asian
checkbox not checked Black or African American
checkbox not checked Native Hawaiian or Other Pacific Islander
checkbox checked White
Citizenship
  Percentage of votes %  
  Percentage of equity %  
  Percentage of total assets
(equity debt plus)
%  
Copy 14. Name  
Address Street