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1. | Legal Name of the Licensee or Permittee AFFILIATED MEDIA, INC. FCC TRUST |
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Mailing Address C/O JOSEPH J. LODOVIC, IV, TRUSTEE 101 WEST COLFAX AVENUE, SUITE 1100 |
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City DENVER |
State or Country (if foreign address) CO |
ZIP Code 80202 - |
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Telephone Number (include area code) 3039546360 |
E-Mail Address (if available) |
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FCC Registration Number: 0019492073 |
Facility ID Number 49632 |
Call Sign KTVA |
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2. | Contact Representative (if other than Licensee or Permittee) KENNETH E. SATTEN |
Firm or Company Name WILKINSON BARKER KNAUER, LLP |
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Telephone Number (include area code) 2027834141 |
E-Mail Address (if available) KSATTEN@WBKLAW.COM |
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3. | For the twelve-month period ended September 30th, has the DTV licensee or permittee provided, at any time during the period, an ancillary or supplementary service as defined by 47 C.F.R. Section 73.624? If "No," complete Question 7 and submit this Report to the Commission. If "Yes," proceed to Questions 4 through 7. |
Yes No | ||
4. | Ancillary/Supplementary Services Provided. Briefly describe below the service provided; whether a fee was charged for the provision of such service; and, if so, the amount of gross revenues received therefrom and the amount of DTV bitstream used to provide such service. [Services Provided] |
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5. | Total amount of gross revenues derived from feeable ancillary or supplementary services: | $ | ||
6. | Has the DTV licensee or permittee remitted to the Commission, through the filing of FCC Form 159, a payment in the amount of 5% of the gross revenues derived from the feeable ancillary or supplementary services? | Yes No N/A |
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7. | Certification. I certify 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. |
Typed or Printed Name of Person Signing JODY J. LODOVIC |
Typed or Printed Title of Person Signing TRUSTEE |
Signature |
Date 11/02/2010 |
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).