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Federal Communications Commission
1270 Fairfield Road
Gettysburg PA 17325-7245
Approved by OMB
3060-0136
Estimated public
burden is 6 minutes
TEMPORARY PERMIT TO OPERATE A
GENERAL MOBILE RADIO SERVICE SYSTEM
Public reporting burden for this collection of information is estimated to average six minutes per response, including the time for revie
instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the colle
of information. Send comments regarding this burden estimate, or any other aspect of this collection of information, inclu
suggestions for reducing the burden to Federal Communications Commission, AMD-PERM, Washington, DC 20554, Paperwork Reducti
Project (3060-0136), or via the Internet to jboley@fcc.gov.
1
INSTRUCTIONS
Use this form only if you want a Temporary Permit in the General Mobile Radio Service to share
multiple-licensed or cooperative-shared mobile relay station while your application, FCC Form 574, is being
processed by the Federal Communications Commission.
Do not use this form if you operate an individual , non-shared station or if you will be the first user of a facility
intended for shared use.
Do not use this form for any radio service other than the General Mobile Radio Service.
Do not use this form unless you are an individual. Partnerships, associations, corporations, and governmental
entites are not eligible for a license in the General Mobile Radio Service.
2
CERTIFICATION
Read, Fill in
Blanks and Sign
I am not a foreign government or a representative thereof.
I am eligible in the General Mobile Radio Service under Rule Section 95.5.
I have not been denied a license or had my license revoked by the FCC.
I am not the subject of any other legal action concerning the operation of a radio station.
My completed Form 574 has been mailed to the FCC.
I hereby certify that:
Mailing Address of Applicant (Number, Street, City, State, ZIP Code)
Name of Applicant
Si t fA li t
Date Form 574 Mailed to FCC