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 | FORMAN, ERIC I |
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| Attention | |
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| First Name / Middle Init / Last Name / Name Suffix | ERIC I FORMAN |
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| Street Address | 4513 CHESTNUT FORK ROAD |
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| Po Box | |
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| Locality | GLOUCESTER |
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| County | Gloucester County |
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| State | VA - Virginia |
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| Postal Code | 230613940 |
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| Zip Location | 37°25'39.8"N 76°32'15.3"W |
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| Maidenhead | FM17rk |
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| FRN | 0004208641 |
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| Geo Region | 4 / VA |
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| Licensee ID/SGIN | L00292569 / 000 |
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| Callsign | KM4VR |
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| Last Action Date | 2007-06-21 |
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| Radio Service | HA - Amateur |
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| App Purpose | MD - Modification |
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| App Source | B - Batch |
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| App Status | G - Granted |
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| Entered Timestamp | 2007-06-21 |
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| Fee Control Num | |
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| Orig Purpose | MD - Modification |
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| Receipt Date | Thu 2007-06-21 |
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| Payment Date | |
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| Is From Vec | N · Y |
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| Is Trustee | |
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| Operator Group | B - 2x2 |
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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 | B / 4 |
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| Prev Callsign / Prev Class | |
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| Vanity Relationship | |
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| Vanity Type | |
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| Fee Exempt / Waiver | N / N |
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