| 1. | Legal Name of the Licensee or Permittee THREE ANGELS BROADCASTING NETWORK, INC. |
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| Mailing Address P O BOX 220 |
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| City WEST FRANKFORT |
State or Country (if foreign address) IL |
ZIP Code 62896 - 0220 |
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| Telephone Number (include area code) 6186274651 |
E-Mail Address (if available) |
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| FCC Registration Number: 0003716198 |
Facility ID Number 67022 |
Call Sign W21CK-D |
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| 2. | Contact Representative (if other than Licensee or Permittee) MOSES PRIMO |
Firm or Company Name 3ABN |
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| Telephone Number (include area code) 6186274651 |
E-Mail Address (if available) MOSES@3ABN.ORG |
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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
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| 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 JAMES W. GILLEY |
Typed or Printed Title of Person Signing PRESIDENT |
| Signature |
Date 11/29/2011 |