Federal Communications Commission
Washington, D.C. 20554
March 2005
FOR FCC USE ONLY
 
Change in Official Mailing Address for Broadcast Station

Read Instructions/FAQ before filling out form

FOR COMMISSION USE ONLY
FILE NO.

1. Legal Name of the Licensee
AFFILIATED MEDIA, INC. FCC TRUST
Mailing Address
C/O RONALD A. MAYO, TRUSTEE
101 WEST COLFAX AVENUE, SUITE 1100

City
DENVER
State or Country (if foreign address)
CO
ZIP Code
80202 -
Telephone Number (include area code)
3039546360
E-Mail Address (if available) 
FCC Registration No
0019492073

If the above fields do not contain the desired values, use the ‘Change Account Address’ button to go to the Account Maintenance screen where you can make changes for this CDBS account.

[Change Account Address]

2. Enter the station information for each facility this address change affects.

[Enter Station Information]


Station Information

Enter one row for each station to be updated. Call Sign, Facility ID, Service and Licensee name must match what is currently reflected in CDBS. You can follow the link to locate the required information in CDBS Public Access
1 Call Sign Facility ID Service Licensee Name
KTVA
49632
DT
AFFILIATED MEDIA, INC. FCC TRUST

2 Call Sign Facility ID Service Licensee Name
K08IZ
49630
TX
AFFILIATED MEDIA, INC. FCC TRUST

3 Call Sign Facility ID Service Licensee Name
K08LW
49641
TX
AFFILIATED MEDIA, INC. FCC TRUST

4 Call Sign Facility ID Service Licensee Name
K11VP
130473
TX
AFFILIATED MEDIA, INC. FCC TRUST

5 Call Sign Facility ID Service Licensee Name
K66CF
49625
TX
AFFILIATED MEDIA, INC. FCC TRUST

6 Call Sign Facility ID Service Licensee Name
KROO
7703
AM
AFFILIATED MEDIA, INC. FCC TRUST

7 Call Sign Facility ID Service Licensee Name
KSWA
35644
AM
AFFILIATED MEDIA, INC. FCC TRUST

8 Call Sign Facility ID Service Licensee Name
KLXK
7702
FM
AFFILIATED MEDIA, INC. FCC TRUST

9 Call Sign Facility ID Service Licensee Name
KWKQ
35643
FM
AFFILIATED MEDIA, INC. FCC TRUST


I certify that the statements in this application are true, complete, and correct to the best of my knowledge and belief, and are made in good faith. I acknowledge that all certifications and attached Exhibits are considered material representations.

Typed or Printed Name of Person Signing
PATRICIA M. CHUH
Typed or Printed Title of Person Signing
FCC COUNSEL
Signature
Date
08/22/2011

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).