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 | Bergen, Douglas P |
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| Attention | |
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| First Name / Middle Init / Last Name / Name Suffix | Douglas P Bergen |
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| Street Address | 9124 Forest Willow Drive |
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| Po Box | |
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| Locality | Indianapolis |
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| County | Hendricks County |
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| State | IN - Indiana |
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| Postal Code | 46234 |
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| Zip Location | 39°48'47.9"N 86°19'34.9"W |
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| Maidenhead | EM69ut |
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| FRN | 0021511506 |
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| Geo Region | 9 / IN |
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| Licensee ID/SGIN | L01701666 / 000 |
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| Callsign | KJ6VNE |
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| Last Action Date | 2015-04-21 |
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| Radio Service | HA - Amateur |
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| App Purpose | AU - Administrative Update |
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| App Source | I - Online |
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| App Status | G - Granted |
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| Entered Timestamp | 2015-04-19 |
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| Fee Control Num | |
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| Orig Purpose | |
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| Receipt Date | Mon 2015-04-20 |
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| Payment Date | |
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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 | T - Technician |
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| New Seq Callsign | |
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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 | |
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| Vanity Type | |
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| Fee Exempt / Waiver | N / N |
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