9. |
(a.) |
List the respondent, and, if other than a natural person, its officers, directors, stockholders and other entities with attributable interests, non-insulated partners and/or members. If a corporation or partnership holds an attributable interest in the respondent, list separately its officers, directors, stockholders and other entities with attributable interests, non-insulated partners and/or members. Create a separate row for each individual or entity. Attach supplemental pages, if necessary.
[Enter Owner Information]
Owner Information
List the respondent, and, if other than a natural person, its officers, directors, stockholders and other entities with attributable interests, non-insulated partners and/or members. If a corporation or partnership holds an attributable interest in the respondent, list separately its officers, directors, stockholders and other entities with attributable interests, non-insulated partners and/or members. Create a separate row for each individual or entity. Attach supplemental pages, if necessary.
(Read carefully - The numbered items below refer to line numbers in the following table.) |
1. Name and address of respondent and each party to the respondent holding an attributable interest (if other than individual also show name, address and citizenship of natural person authorized to vote the stock or holding the attributable interest). List the respondent first, officers next, then directors and, thereafter, remaining stockholders and other entities with attributable interests, and partners.
2. Gender (male or female).
3. Ethnicity (check one).
4. Race (select one or more).
5. Citizenship. 6. Positional interest: Officer, director, general partner, limited partner, LLC member, investor/creditor attributable under the Commission's equity/debt plus standard, etc.
7. Percentage of votes.
8. Percentage of total assets (equity debt plus).
|
1. Name and Address |
BUSTOS MEDIA INVESTMENT ASSOCIATES, LLC, 1750 LAGOON VIEW DRIVE, TIBURON CA 94920 |
2. Gender (male or female) |
N/A
|
3. Ethnicity (check one) |
Hispanic or Latino
Not Hispanic or Latino |
4. Race (select one or more) |
American Indian or Alaska Native
Asian
Black or African American
Native Hawaiian or Other Pacific Islander
White
|
5. Citizenship |
US |
6. Positional Interest |
RESPONDENT |
7. Percentage of votes |
0.00 |
8. Percentage of total assets (equity debt plus) |
0.00 |
1. Name and Address |
JAVIER D. PEREZ, 984 TRINITY HILLS LANE, LIVERMORE CA 94550 |
2. Gender (male or female) |
Male
|
3. Ethnicity (check one) |
Hispanic or Latino
Not Hispanic or Latino |
4. Race (select one or more) |
American Indian or Alaska Native
Asian
Black or African American
Native Hawaiian or Other Pacific Islander
White
|
5. Citizenship |
US |
6. Positional Interest |
MEMBER |
7. Percentage of votes |
33.33 |
8. Percentage of total assets (equity debt plus) |
33.33 |
1. Name and Address |
CARLOS A. DUHARTE, 748 NEWMAN DRIVE, SOUTH SAN FRANCISCO CA 94080 |
2. Gender (male or female) |
Male
|
3. Ethnicity (check one) |
Hispanic or Latino
Not Hispanic or Latino |
4. Race (select one or more) |
American Indian or Alaska Native
Asian
Black or African American
Native Hawaiian or Other Pacific Islander
White
|
5. Citizenship |
US |
6. Positional Interest |
MEMBER |
7. Percentage of votes |
16.67 |
8. Percentage of total assets (equity debt plus) |
16.67 |
1. Name and Address |
SALVADOR HOMERO CAMPOS,103 REEVES WAY, FOLSOM CA 95630 |
2. Gender (male or female) |
Male
|
3. Ethnicity (check one) |
Hispanic or Latino
Not Hispanic or Latino |
4. Race (select one or more) |
American Indian or Alaska Native
Asian
Black or African American
Native Hawaiian or Other Pacific Islander
White
|
5. Citizenship |
US |
6. Positional Interest |
MEMBER |
7. Percentage of votes |
8.33 |
8. Percentage of total assets (equity debt plus) |
8.33 |
1. Name and Address |
FELIPE CHAVEZ, 9124 GRECO COURT, SACRAMENTO CA 95829 |
2. Gender (male or female) |
Male
|
3. Ethnicity (check one) |
Hispanic or Latino
Not Hispanic or Latino |
4. Race (select one or more) |
American Indian or Alaska Native
Asian
Black or African American
Native Hawaiian or Other Pacific Islander
White
|
5. Citizenship |
US |
6. Positional Interest |
MEMBER |
7. Percentage of votes |
6.67 |
8. Percentage of total assets (equity debt plus) |
6.67 |
1. Name and Address |
JOSE S. REYNOSO, 9083 ACORN RIDGE CIRCLE, ELK GROVE CA 95758 |
2. Gender (male or female) |
Male
|
3. Ethnicity (check one) |
Hispanic or Latino
Not Hispanic or Latino |
4. Race (select one or more) |
American Indian or Alaska Native
Asian
Black or African American
Native Hawaiian or Other Pacific Islander
White
|
5. Citizenship |
US |
6. Positional Interest |
MEMBER |
7. Percentage of votes |
5.67 |
8. Percentage of total assets (equity debt plus) |
5.67 |
1. Name and Address |
HUMBERTO C. PEREZ, 1153 AMBERHILL AVENUE, GALT CA 95632 |
2. Gender (male or female) |
Male
|
3. Ethnicity (check one) |
Hispanic or Latino
Not Hispanic or Latino |
4. Race (select one or more) |
American Indian or Alaska Native
Asian
Black or African American
Native Hawaiian or Other Pacific Islander
White
|
5. Citizenship |
US |
6. Positional Interest |
MEMBER |
7. Percentage of votes |
10.00 |
8. Percentage of total assets (equity debt plus) |
10.00 |
1. Name and Address |
ANA A. JAUREGUI-PEREZ, 972 ANDERSON CIRCLE, WOODLAND CA 95776 |
2. Gender (male or female) |
Female
|
3. Ethnicity (check one) |
Hispanic or Latino
Not Hispanic or Latino |
4. Race (select one or more) |
American Indian or Alaska Native
Asian
Black or African American
Native Hawaiian or Other Pacific Islander
White
|
5. Citizenship |
US |
6. Positional Interest |
MEMBER |
7. Percentage of votes |
5.00 |
8. Percentage of total assets (equity debt plus) |
5.00 |
1. Name and Address |
CESAR VALDIOSERA , 3100 FITE CIRCLE, SACRAMENTO CA 95827 |
2. Gender (male or female) |
Male
|
3. Ethnicity (check one) |
Hispanic or Latino
Not Hispanic or Latino |
4. Race (select one or more) |
American Indian or Alaska Native
Asian
Black or African American
Native Hawaiian or Other Pacific Islander
White
|
5. Citizenship |
US |
6. Positional Interest |
MEMBER |
7. Percentage of votes |
4.50 |
8. Percentage of total assets (equity debt plus) |
4.50 |
1. Name and Address |
CARLOS MARTIN VALDEZ, 2722 S. REDWOOD RD. #1, SALT LAKE CITY, UT 84119 |
2. Gender (male or female) |
Male
|
3. Ethnicity (check one) |
Hispanic or Latino
Not Hispanic or Latino |
4. Race (select one or more) |
American Indian or Alaska Native
Asian
Black or African American
Native Hawaiian or Other Pacific Islander
White
|
5. Citizenship |
US |
6. Positional Interest |
MEMBER |
7. Percentage of votes |
5.00 |
8. Percentage of total assets (equity debt plus) |
5.00 |
1. Name and Address |
ED DISTEL, 10866 S. LANGFORD LN, #1064, SOUTH JORDAN, UT 84095 |
2. Gender (male or female) |
Male
|
3. Ethnicity (check one) |
Hispanic or Latino
Not Hispanic or Latino |
4. Race (select one or more) |
American Indian or Alaska Native
Asian
Black or African American
Native Hawaiian or Other Pacific Islander
White
|
5. Citizenship |
US |
6. Positional Interest |
MEMBER |
7. Percentage of votes |
2.50 |
8. Percentage of total assets (equity debt plus) |
2.50 |
1. Name and Address |
ANGELICA GODINEZ, 5712 DEEPDALE WAY, ELK GROVE, CA 95758 |
2. Gender (male or female) |
Female
|
3. Ethnicity (check one) |
Hispanic or Latino
Not Hispanic or Latino |
4. Race (select one or more) |
American Indian or Alaska Native
Asian
Black or African American
Native Hawaiian or Other Pacific Islander
White
|
5. Citizenship |
US |
6. Positional Interest |
MEMBER |
7. Percentage of votes |
2.33 |
8. Percentage of total assets (equity debt plus) |
2.33 |
1. Name and Address |
THOMAS MOFFET, 1750 LAGOON VIEW DRIVE, TIBURON CA 94920 |
2. Gender (male or female) |
Male
|
3. Ethnicity (check one) |
Hispanic or Latino
Not Hispanic or Latino |
4. Race (select one or more) |
American Indian or Alaska Native
Asian
Black or African American
Native Hawaiian or Other Pacific Islander
White
|
5. Citizenship |
CA |
6. Positional Interest |
MANAGER |
7. Percentage of votes |
0.00 |
8. Percentage of total assets (equity debt plus) |
0.00 |
|
(b) |
Respondent certifies that equity and financial interests not set forth in response to Question 9(a) are non-attributable. |
Yes No
N/A
See Explanation in
[Exhibit 2]
|
(c) |
Is the respondent or any party holding an attributable interest in the respondent also the holder of an attributable interest in any other broadcast station or in any cable or newspaper entities in the same market or with overlapping signals in the same broadcast service, as described in 47 C.F.R. Sections 73.3555 and 76.501? |
Yes No |
If "Yes", submit an Exhibit identifying the holder of that other attributable interest, listing the call signs, locations and facilities identifiers of such other broadcast stations, and describing the nature and size of the ownership interest and the positions held in the other broadcast, cable or newspaper entities. |
[Exhibit 3] |
(d) |
Are any of the individuals listed in response to Question 9(a) related as parent-child, husband-wife, brothers and sisters?
|
Yes No
|
|
If "Yes", submit an Exhibit setting forth full information as to the family relationship
|
[Exhibit 4]
|
(e) |
Is respondent seeking an attribution exemption for any officer or director with duties unrelated to the licensee or permittee?
If "Yes", submit an Exhibit identifying that individual by name and title, fully describing that individual's duties and responsibilities, and explaining why that individual should not be attributed an interest.
|
Yes No
[Exhibit 5]
|
|