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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:
- - - - - - - - - -	- - - - - - - - - -

Fee Computation
1. Gross Revenue (excluding non-cash payments in goods and/or services)
2. Network Revenue for Programs of Licensed Networks
3. Advertising Agency Commissions
4. Revenue for Political Broadcasts
5. Less: Agcy. Comm included in Advertising Agency Commissions
7. Bad Debts
8. Less: Bad Debt Recoveries
10. Rate Card Discounts
11. Net Revenue Cleared at the Source

Enter Weighted Hours of Programs as reported on Monthly Reports
Jan.		Feb.		Mar.		Apr.
May		Jun.		Jul.		Aug.
Sep.		Oct.		Nov.		Dec.

Enter Weighted Hours Subject to Fee as reported on Monthly Reports
Jan.		Feb.		Mar.		Apr.
May		Jun.		Jul.		Aug.
Sep.		Oct.		Nov.		Dec.