Submitted by:
Name:	Title:
Account Number:	Returned Document Format: Adobe PDF "Form Data File" (FDF) saved to disk Original Report: Revised Report:

Reporting Period	Station Covered by This Report
Calendar Year Basis SELECT ONE 2003 2002 2001 2000 1999 1996 1997 1998 If less than full year Reporting Period: (MM/DD/YY) / / to / / *Note: You cannot span more than 1 calendar year.		AM	FM
	Call Letters: Licensee Address

Other Stations covered by this Report
Co-Owned stations (80% simulcast or < 75,000 gross)	Time Broker for:
- - - - - - - - - -	- - - - - - - - - -

Accounting Method:
Billing Basis Cash Basis	If station is brokered by another station enter calls: -
If all revenue to be reported by broker

Gross Revenue Up to $150,000
1. Gross Revenue (excluding non-cash payments in goods and/or services)

Please note: stations with gross revenue up to $150,000 cannot itemize their deductions.

Gross Revenue Over $150,000
3. Gross Revenue (excluding non-cash payments in goods and/or services)
4. Advertising Agency Commissions
5. Revenue for Political Broadcasts
6. Less: Agcy. Comm included in 4 above
8. Bad Debts
9. Less: Bad Debt Recoveries
11. Rate Card Discounts

22. News service
23. Remote Pickups
24. Broadcast Rights
25. Other. Specify License Paragraph

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