Field Name · Applicant
Italic names are derived; accent values differ from the applicant’s prior license.
| Applicant Type | B - Amateur Club |
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| Entity Type | L - Licensee or Assignee |
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| Entity Name | QCWA EDISON CHAPTER 196 |
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| Attention | JOHN T BURIK |
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| First Name / Middle Init / Last Name / Name Suffix | |
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| Street Address | 2235 VIRGINIA AVE SE |
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| Po Box | |
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| Locality | FT MYERS |
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| County | Lee County |
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| State | FL - Florida |
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| Postal Code | 339054713 |
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| Zip Location | 26°40'03.8"N 81°45'50.2"W |
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| Maidenhead | EL96cq |
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| FRN | 0006907299 |
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| Geo Region | 4 / FL |
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| Licensee ID/SGIN | L00501545 / 000 |
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| Callsign | KG4STZ |
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| Last Action Date | 2004-04-30 |
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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 | 2004-04-12 |
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| Fee Control Num | 0404128994885369 |
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| Orig Purpose | MD - Modification |
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| Receipt Date | Mon 2004-04-12 |
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| Payment Date | 2004-04-13 |
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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 | trustee: E - Amateur Extra |
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| New Seq Callsign | N |
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| Trustee Callsign | K3QC |
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| Trustee Name | Burik, John T |
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| ULS Group / ULS Region | D / 4 |
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| Prev Callsign / Prev Class | |
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| Vanity Relationship | |
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| Vanity Type | F - By List (Club) |
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| Fee Exempt / Waiver | N / N |
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