Federal Communications Commission
Washington, D.C. 20554 |
Approved by OMB
3060-0084 (June 2002) |
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FOR FCC USE ONLY |
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Ownership Report For Noncommercial Educational Broadcast Station
Read INSTRUCTIONS Before Filling Out Form
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FOR COMMISSION USE ONLY
FILE NO.
BON - 20110912AHS |
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Section I - General
1. |
Legal Name of the Licensee/Permittee
RADIO FREE PALMER, INC.
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Mailing Address
PO BOX 3454
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City
PALMER |
State or Country (if foreign address)
AK |
ZIP Code
99645 - |
Telephone Number (include area code)
9079827149 |
E-Mail Address (if available)
MANAGER@RADIOFREEPALMER.ORG |
FCC Registration Number:
0015715576
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Call Sign
KVRF |
Facility ID Number
177165 |
2. |
Contact Representative (if other than Licensee/Permittee)
MIKE CHMIELEWSKI
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Firm or Company Name
RADIO FREE PALMER
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Mailing Address
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City
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State or Country (if foreign address)
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ZIP Code
- |
Telephone Number (include area code)
9079827149
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E-Mail Address (if available)
MANAGER@RADIOFREEPALMER.ORG
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3. |
Name of entity, if other than licensee or permittee, for which report is filed
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Mailing Address
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City |
State or Country (if foreign address) |
ZIP Code - |
Telephone Number (include area code) |
E-Mail Address (if available) |
Section II - Ownership Information
4. |
All of the information furnished in this Report is accurate as of 09/12/2012 (Date must comply with 47 C.F.R. Section 73.3615(d), i.e., information must be current within 60 days of filing of this report, when 4(a) below is checked.)
This Report is filed for (check one)
a. |
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Biennial |
b. |
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Transfer of Control or Assignment of License/Permit |
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c. |
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Other |
d. |
Amendment to pending application |
for the following stations:
[Enter Station Information]
Station List
This Report is filed for the following stations:
Call Letters
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Facility ID Number
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Location (City/State)
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Class of service
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KVRF |
177165 |
SUTTON AK |
FM |
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5. |
List all contracts and other instruments required to be filed by 47 C.F.R. Section 73.3613. (Only licensees, permittees, or a reporting entity with a majority interest in or that otherwise exercises de facto control over the subject licensee or permittee shall respond.)
[Enter Contract/Instrument Information]
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6. |
Is the governing board directly or indirectly under the control of another entity? |
Yes No
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If Yes, is a separate FCC Form 323-E submitted for such entity? |
Yes No
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7. |
List officers, members of governing board, and holders of 1% or more ownership interest, if any. Use one column for each individual or entity. Attach supplemental pages, if necessary. |
[Enter Owner Information]
Owner Information
List officers, members of governing board, and holders of 1% or more ownership interest, if any. Use one column for each individual or entity. Attach supplemental pages if necessary.
(Read carefully - The numbered items below refer to line numbers in the following table.) |
a. Name and address of officer, member of governing board, and holders of 1% or more ownership interest (if other than individual also show name, address and citizenship of natural person authorized to vote the interest). List officers first, then board members, and thereafter, holders of 1% or more ownership interest, if any.
b. Citizenship.
c. Office held.
d. Percent of interest held.
e. Principal profession or occupation.
f. By whom appointed or elected.
g. Existing interests in any other broadcast station, including the nature and size of such interests.
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a. Name and Address. |
BRIAN MEAD |
b. Citizenship. |
US |
c. Office held.
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PRESIDENT |
d. Percent of interest held.
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14.30 |
e. Principal profession or occupation.
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TEACHER |
f. By whom appointed or elected.
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MEMBERS |
g. Existing interests
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N/A |
a. Name and Address. |
LEE M. HENRIKSON |
b. Citizenship. |
US |
c. Office held.
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SECRETARY |
d. Percent of interest held.
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14.30 |
e. Principal profession or occupation.
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UNIVERSITY FACULTY |
f. By whom appointed or elected.
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MEMBERS |
g. Existing interests
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N/A |
a. Name and Address. |
CAROLYN COVINGTON |
b. Citizenship. |
US |
c. Office held.
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TREASURER |
d. Percent of interest held.
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14.30 |
e. Principal profession or occupation.
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RETIRED |
f. By whom appointed or elected.
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MEMBERS |
g. Existing interests
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N/A |
a. Name and Address. |
JAIME RODRIGUEZ |
b. Citizenship. |
US |
c. Office held.
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VICE PRESIDENT |
d. Percent of interest held.
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14.30 |
e. Principal profession or occupation.
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CONSTRUCTION ADMIN |
f. By whom appointed or elected.
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MEMBERS |
g. Existing interests
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N/A |
a. Name and Address. |
MICHAEL R. CHMIELEWSKI |
b. Citizenship. |
US |
c. Office held.
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MEMBER |
d. Percent of interest held.
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14.30 |
e. Principal profession or occupation.
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RETIRED |
f. By whom appointed or elected.
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MEMBERS |
g. Existing interests
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NA |
a. Name and Address. |
DAVID CHEEZEM |
b. Citizenship. |
US |
c. Office held.
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MEMBER |
d. Percent of interest held.
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14.30 |
e. Principal profession or occupation.
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BOOKSTORE OWNER |
f. By whom appointed or elected.
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MEMBERS |
g. Existing interests
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N/A |
a. Name and Address. |
WILLIAM TULL |
b. Citizenship. |
US |
c. Office held.
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MEMBER |
d. Percent of interest held.
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14.30 |
e. Principal profession or occupation.
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RETIRED ATTORNEY |
f. By whom appointed or elected.
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BOARD |
g. Existing interests
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N/A |
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SECTION III - CERTIFICATION
I certify that I am MICHAEL CHMIELEWSKI
(Official Title)
of RADIOFREEPALMER
(Exact legal title or name of respondent)
and that I have examined this Report and that to the best of my knowledge and belief, all statements in this Report are true, correct and complete.
(Date of certification must be within 60 days of the date shown in Question 4, Section II and in no event prior to that date.)
Signature
MICHAEL CHMIELEWSKI |
Date
09/12/2011 |
Telephone Number of Respondent (Include area code) 9079827149 |
WILLFUL FALSE STATEMENTS ON THIS FORM ARE PUNISHABLE BY FINE AND/OR IMPRISONMENT (U.S. CODE, TITLE 18, SECTION 1001), AND/OR REVOCATION OF ANY STATION LICENSE OR CONSTRUCTION PERMIT (U.S. CODE, TITLE 47, SECTION 312(a)(1)), AND/OR FORFEITURE (U.S. CODE, TITLE 47, SECTION 503).
Exhibits