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 Dam, Willem J |
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| Attention | |
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| First Name / Middle Init / Last Name / Name Suffix | Willem J Van Dam |
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| Street Address | 9129 SW 5th St Apt C |
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| Po Box | |
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| Locality | Boca Raton |
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| County | Palm Beach County |
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| State | FL - Florida |
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| Postal Code | 33428 |
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| Zip Location | 26°21'10.5"N 80°12'28.6"W |
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| Maidenhead | EL96vi |
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| FRN | 0005429543 |
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| Geo Region | 4 / FL |
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| Licensee ID/SGIN | L00414889 / 000 |
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| Callsign | KG4PVX |
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| Last Action Date | 2004-01-17 |
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| Radio Service | HA - Amateur |
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| App Purpose | MD - Modification |
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| App Source | I - Online |
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| App Status | G - Granted |
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| Entered Timestamp | 2003-12-30 |
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| Fee Control Num | 0312308994898722 |
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| Orig Purpose | MD - Modification |
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| Receipt Date | Tue 2003-12-30 |
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| Payment Date | 2003-12-31 |
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| Is From Vec | |
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| Is Trustee | |
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| Operator Group | C - 1x3 |
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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 | C / 4 |
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| Prev Callsign / Prev Class | |
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| Vanity Relationship | |
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| Vanity Type | E - By List |
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| Fee Exempt / Waiver | N / N |
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