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 |
JOHN E HARRIS III, 207 N 5 ST, FARGO, ND 58102 |
2. Gender (male or 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 |
Y |
6. Positional Interest |
|
7. Percentage of votes |
|
8. Percentage of total assets (equity debt plus) |
|
1. Name and Address |
GREG DANDEWICH, 141 SUNNYSIDE BLVD, WINNIPEG, MB R3J 3M1 |
2. Gender (male or 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 |
N |
6. Positional Interest |
|
7. Percentage of votes |
|
8. Percentage of total assets (equity debt plus) |
|
1. Name and Address |
DEB MATHERN, 2739 WHEATLAND DR S, FARGO, ND 58103 |
2. Gender (male or 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 |
Y |
6. Positional Interest |
|
7. Percentage of votes |
|
8. Percentage of total assets (equity debt plus) |
|
1. Name and Address |
PAT BERGER, 320 17TH AVE S, GRAND FORKS, ND 58201 |
2. Gender (male or 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 |
Y |
6. Positional Interest |
|
7. Percentage of votes |
|
8. Percentage of total assets (equity debt plus) |
|
1. Name and Address |
PAUL EBELTOFT, 46 W 2 ST, DICKINSON, ND 58601 |
2. Gender (male or 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 |
Y |
6. Positional Interest |
|
7. Percentage of votes |
|
8. Percentage of total assets (equity debt plus) |
|
1. Name and Address |
KEN BULL, 245 RITA ST, WINNIPEG, MB R3J 2Y3 |
2. Gender (male or 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 |
N |
6. Positional Interest |
|
7. Percentage of votes |
|
8. Percentage of total assets (equity debt plus) |
|
1. Name and Address |
BRITT JACOBSON, 6733 127TH AVE NE, PARK RIVER, ND 58270 |
2. Gender (male or 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 |
Y |
6. Positional Interest |
|
7. Percentage of votes |
|
8. Percentage of total assets (equity debt plus) |
|
1. Name and Address |
SARAH SMITH WARREN, 8562 28TH ST NE, WARWICK, ND 58381 |
2. Gender (male or 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 |
Y |
6. Positional Interest |
|
7. Percentage of votes |
|
8. Percentage of total assets (equity debt plus) |
|
1. Name and Address |
DICK KLOUBEC, 3233 16TH AVE SW APT 202, FARGO, ND 58103 |
2. Gender (male or 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 |
Y |
6. Positional Interest |
|
7. Percentage of votes |
|
8. Percentage of total assets (equity debt plus) |
|
1. Name and Address |
ERIK KRINGLIE, 940 14TH AVE SW, VALLEY CITY, ND, 58072 |
2. Gender (male or 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 |
Y |
6. Positional Interest |
|
7. Percentage of votes |
|
8. Percentage of total assets (equity debt plus) |
|
1. Name and Address |
JOHN PETRIK, 417 24TH ST NW, MINOT, ND 58703 |
2. Gender (male or 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 |
Y |
6. Positional Interest |
|
7. Percentage of votes |
|
8. Percentage of total assets (equity debt plus) |
|
1. Name and Address |
ANDREW MARAGOS, 125 6 AVE SE, MINOT, ND 58703 |
2. Gender (male or 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 |
Y |
6. Positional Interest |
|
7. Percentage of votes |
|
8. Percentage of total assets (equity debt plus) |
|
1. Name and Address |
JERRY NAGEL, 16982 STAKKE LAKE RD, LAKE PARK, MN 56554 |
2. Gender (male or 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 |
Y |
6. Positional Interest |
|
7. Percentage of votes |
|
8. Percentage of total assets (equity debt plus) |
|
1. Name and Address |
RITA KELLY, 900 PROSPECT PT, BISMARCK, ND 58501 |
2. Gender (male or 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 |
Y |
6. Positional Interest |
|
7. Percentage of votes |
|
8. Percentage of total assets (equity debt plus) |
|
1. Name and Address |
PAUL NYREN, 7276 14TH ST NW, LOT 8, GARRISON, ND 58540 |
2. Gender (male or 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 |
Y |
6. Positional Interest |
|
7. Percentage of votes |
|
8. Percentage of total assets (equity debt plus) |
|
1. Name and Address |
KAREN KREIL, 831 N MANDAN ST, BISMARCK, ND 58501 |
2. Gender (male or 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 |
Y |
6. Positional Interest |
|
7. Percentage of votes |
|
8. Percentage of total assets (equity debt plus) |
|
1. Name and Address |
DEVAN TOWERS, 814 N DRIVE, WINNIPEG MB R3T0A5 |
2. Gender (male or 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 |
N |
6. Positional Interest |
|
7. Percentage of votes |
|
8. Percentage of total assets (equity debt plus) |
|
1. Name and Address |
KENNETH A ZEALAND, 30 ENVOY CRESCENT, WINNIPEG, MB R2V3K6 |
2. Gender (male or 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 |
N |
6. Positional Interest |
|
7. Percentage of votes |
|
8. Percentage of total assets (equity debt plus) |
|
|
(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]
|
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