*Pages 1--1 from  59708.xls*
 APPLICATION 
 FOR 
 INCLUSION 


 IN 
 THE 


 REGION 


 55 
 NEW 


 YORK-  BUFFALO 


 PLAN 


 FOR 
 CHANNELS 


 IN 
 THE 


 821-  824 


 / 
 866-  869 


 MHZ 
 BAND 


 1. 
 I.  D. 
 Number: 


 ______________________ 


 _  2. 
 Status: 


 ________________________ 


 3. 
 Service: 


 __________________________________ 


 4. 
 Application 


 Date: 
 __ 
 / 
 __ 


 / 
 __ 


 5. 
 Page: 


 __ 
 of 
 __ 


 6 
 Agency 


 Name: 
 _______________________________________________________ 


 7. 
 Agency 


 Street: 
 _____________________________ 


 8. 
 Agency 


 City:_________________________________ 


 9. 
 Agency 


 County: 
 _____________________  10. 


 Agency 
 State: 
 ___________________  11. 


 Agency 
 Zip 
 Code: 


 _____________  12. 


 Contact 
 Name: 
 ________________________________________________ 


 13. 
 Preparer 


 Name: 
 ______________________________________________________ 


 14. 
 Preparer 


 Phone: 
 ___________________________ 


 15. 
 Contact 


 Phone: 
 _______________________________ 


 16. 
 Area 


 of 
 Operation: 


 Is 
 ________  Miles 


 Radius 
 of 
 Station 


 A 


 17. 
 System 


 License? 


 Yes 
 No 
 19. 
 Previous 


 Call 
 Signs: 


 or 
 is 
 _______ 


 _Miles 
 radius 
 of 
 Coordinates 


 18. 
 New 
 Station 


 Lat. 
 ____ 


 - 
 ____ 


 - 
 ____ 


 Long. 
 ____ 
 - 
 ____ 


 - 
 ____ 


 New 
 Single 


 Frequency 


 Or 
 is: 


 Countywide 


 Statewide 
 Nationwide 


 New 
 Frequency 


 Pair 
 (Duplex/  Mobile 


 Relay) 


 Other 
 ___________________________________ 


 Modification 


 20. 
 Frequency 


 Band 


 21. 
 Trunked 


 23. 
 Number 


 of 
 Mobiles 


 by 
 Category 


 24. 
 Location 


 of 
 Primary 


 Control 


 Use 
 this 
 form 


 only 
 to 
 register 


 for 


 Conventional 


 Vehicular: 


 allocation 
 of 
 800 


 MHz 
 channels 


 under 


 Slow 
 Growth 


 Portable: 


 Docket 
 87-  112, 
 Regional 


 Plan 


 22. 
 Number 


 of 
 Requested 


 Channels: 
 _______  Aircraft:  Marine: 


 25. 
 Eligibility 


 Rules: 
 ____________________ 


 Pagers: 


 29. 
 Station 


 Street 
 or 
 Geographical 


 Location 


 30. 
 City 


 31. 
 County 


 / 
 32.  State 


 26. 
 Concurrences: 


 Agency 


 Y 
 N 
 Agency 


 Y 
 N 


 A  B  C 
 27. 
 Applicant 


 Remarks: 


 D  E 
 28. 
 Coordinator 


 Remarks: 


 F  33. 
 34. 


 35. 


 36. 
 37. 
 38. 


 39. 
 40. 
 41. 
 42. 


 43. 
 44. 


 45. 


 46. 


 47. 


 48. 


 49. 
 50. 
 51. 


 N 
 M 


 E 


 No. 
 Out- 


 Ant. 
 Ant. 
 Ht. 


 Trans 
 Receive 


 E 
 O 


 X 


 Trans 


 Receive 


 Of 
 Emission 


 put 
 Ant. 


 Down 
 Ground 
 to 


 Squelch 
 Squelch 


 W 
 D 
 T 
 Frequenc 


 y 
 Frequency 


 Class 
 Units 
 Designator 


 Power 
 Gain 
 ERP 


 DIR 
 Tilt 
 AAT 


 Elev. 


 Tip 
 Latitude 


 Longitude 
 Tone 
 Tone 


 A  B  C  D  E  F 
1