Field Name · Applicant
Italic names are derived; accent values differ from the applicant’s prior license.
| Applicant Type | I - Individual |
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| Entity Type | L - Licensee or Assignee |
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| Entity Name | VAN DER BURGT, MARTIN J |
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| Attention | |
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| First Name / Middle Init / Last Name / Name Suffix | MARTIN J VAN DER BURGT |
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| Street Address | 3020 DOROTHY LN |
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| Po Box | |
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| Locality | RICHMOND |
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| County | Wayne County |
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| State | IN - Indiana |
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| Postal Code | 473746740 |
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| Zip Location | 39°49'51.9"N 84°53'23.0"W |
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| Maidenhead | EM79nt |
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| FRN | 0002695450 |
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| Geo Region | 9 / IN |
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| Licensee ID/SGIN | L00153731 / 000 |
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| Callsign | KA9MSR |
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| Last Action Date | 1999-11-06 |
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| Radio Service | HA - Amateur |
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| App Purpose | MD - Modification |
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| App Source | M - Manual |
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| App Status | D - Dismissed |
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| Entered Timestamp | 1999-09-20 |
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| Fee Control Num | 9909138130856018 |
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| Orig Purpose | MD - Modification |
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| Receipt Date | Thu 1999-09-09 |
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| Payment Date | 1999-09-21 |
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| Is From Vec | |
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| Is Trustee | |
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| Operator Group | D - 2x3 |
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| Licensee Class | E - Amateur Extra |
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| New Seq Callsign | N |
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| Trustee Callsign | |
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| Trustee Name | |
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| ULS Group / ULS Region | D / 9 |
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| Prev Callsign / Prev Class | |
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| Vanity Relationship | Parent |
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| Vanity Type | B - Relative of Deceased |
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| Fee Exempt / Waiver | N / N |
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