Fcc 605 Schedule D -Schedule For Additional Data In The Amateur Radio Service (Page 2 of 2) in pdf

FCC 605

Schedule for Additional Data in the

Approved by OMB

Schedule D

Amateur Radio Service

3060 - 0850

See 605 Main Form Instructions

for public burden estimate

AMATEUR STATION CALL SIGN CHANGE AND VANITY CALL SIGN REQUEST

Systematic Call Sign Change

1) Is this a request to change your station call sign to the next systematically available call sign?

(

)

Yes No

If you answered Yes (‘Y’) to Item 1, do not complete Items 2 and 3 on this schedule. If completing Item 2, Item 1 must be answered No (‘N’).

Vanity Call Sign Change

2) I hereby apply for a vanity call sign under the following eligibility: (make an ‘X’ in the appropriate box and enter the required information):

(Only 1 block may be checked)

FORMER PRIMARY STATION HOLDER: I request call sign _______________ be shown on my primary station license. By checking

this box, I certify that the call sign being requested was previously assigned to my station and that I can provide documentation, if

requested.

CLOSE RELATIVE OF FORMER HOLDER: I request call sign _______________ be shown on my primary station license. By

checking this box, I certify that the call sign being requested was shown on the primary station license of my deceased spouse, child,

grandchild, stepchild, parent, grandparent, stepparent, brother, sister, stepbrother, stepsister, aunt, uncle, niece, nephew, or in-law

within the past 2 years and that I can provide documentation, if requested.

Enter the deceased relationship to you:

____________________________________.

FORMER CLUB STATION HOLDER: I request call sign _______________ be shown on the license for the club station, for which I

am the license trustee. By checking this box, I certify that the call sign being requested was shown on the license for this club station

within the past 2 years and that I can provide documentation, if requested.

CLUB STATION WITH CONSENT OF FORMER HOLDER OR CLOSE RELATIVE OF FORMER HOLDER: I request that the call sign

_______________ be shown on the license for the club station, for which I am the license trustee. By checking this box, I certify that

the call sign being requested was shown on the primary station license of a person now deceased within the past 2 years. I also

certify that I am acting with written consent of the former holder now deceased or of the deceased former holder's spouse, child,

grandchild, stepchild, parent, grandparent, stepparent, brother, sister, stepbrother, stepsister, aunt, uncle, niece, nephew, or in-law,

and I can provide documentation of that consent, if requested.

Enter "self" if deceased licensee gave consent or the relationship of the person giving consent:

____________________________________________.

PRIMARY STATION PREFERENCE LIST: I request the first assignable call sign from my preference list in item #3 be shown on the

license for my primary station.

CLUB STATION PREFERENCE LIST: I request the first assignable call sign from my preference list in item #3 be shown on the

license for the club station, for which I am the license trustee.

Vanity Call Sign PREFERENCE LIST

3) Select your preference list of vanity call signs very carefully. Give exact prefix, numeral, and suffix for each call sign

11)

16)

21)

12)

17)

22)

13)

18)

23)

14)

19)

24)

10)

15)

20)

25)

Note: If none of the call signs you selected are assignable, you will retain your existing call sign.

FCC 605 - Schedule D

April 2014 - Page 1

Fcc 605 Schedule D -Schedule For Additional Data In The Amateur Radio Service Page 2

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