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Get NCVEC 605 2000

Reet or P.O. Box) SOCIAL SECURITY NUMBER / TIN (OR FCC LICENSEE ID #) CITY STATE CODE DAYTIME TELEPHONE NUMBER (Include Area Code) OPTIONAL FAX NUMBER (Include Area Code) OPTIONAL Type of Applicant: STATION CALL SIGN (IF ANY) ZIP CODE (5 or 9 Numbers) Amateur Recreation ! Individual ! Club ! Military ! RACES E-MAIL ADDRESS (OPTIONAL) ENTITY NAME (IF CLUB, MILITARY RECREATION, RACES) TRUSTEE OR CUSTODIAN CALL SIGN (Modify Only) SIGNATURE OF RESPONSIBLE CLUB OFFICIAL I HEREBY APPLY F.

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