What You Need To Know About DTV

“Are You Prepared For the Digital TV

Transition Coming on February 17, 2009?”

- FCC Chairman Kevin

J.

Martin

YOU HAVE 3 CHOICES

COUPONS FOR CONVERTER BOXES

Connect your older T V to a digital-

to-analog converter box; or

Each U S. household can get two $40 coupons to help

pay for two digital-to-analog converter boxes.

Buy a digital television

(a T V with a built-in digital tuner); or

Subscribe to a service such as

cable or satellite TV.

Consumers can apply for coupons online at

www.DTV2009.gov; mail the application below to PO Box

2000, Portland, OR 97208-2000; fax the application below

to 1-877-DTV-4M E2; or call 1-888-DTV-2009

(1-888-388-2009), TTY 1-877-530-2634 (English TTY), or

1-866-495-1161 (Spanish TTY).

For more information about the digital transition call 1-8 8 8 -C A LL-FC C (1-888-225-5322) (voice)

or 1-8 8 8 -T E L L -F C C (1-888-835-5322) (TTY) or go to W W W .DTV.GOV

TV CO N VER TER BOX

FAX APPLICATIONS TO:

1

-

877

-DTV-

4

ME

2

COUPON PROGRAM

MAIL APPLICATIONS TO:

PO BOX

2000

,

PORTLAND,

o r

97208-2000

p o

Box

2000

, Portland. OR

97208

ALL APPLICATIONS MUST BE SUBMITTED BY MARCH 31, 2009.

Form Approved

OMB No.

0000

-

002*1

COUPON APPLICATION

All information must be filled out. Please type or print clearly.

This Application is to apply for a $40 Coupon which can be used towards the purchase of a TV

converter box.

1. Your Name and Address.

NAME

First

HOME

A D D R ESS

Street Address

Middle

Last

Apt#

City

State

Zip

If the US Post Office does not deliver mail to your Home Address, provide as much information as you

can above regarding your Horne Address and provide your Mailing Address below.

MAILING

A D D R E S S

If different

Street Address - or - P.O. Box #

Apt#

than above

City

State

Zip

2. TV Service:

C h e ck the statem ent below that best d escribes your household.

1

All or some of the TVs in my house are connected to one or more pay services, such as cable or satellite.

1

1

None of the TVs in my house are connected to one or more pay services, such as cable or satellite.

3. Coupons Requested:

How m any coupons do you w ant?

□ ONE - OR - □ TWO

4.

Signature:

By signing below, you declare that the above is true and correct.

Signature

Date

Notwithstanding any other provision of the law, no person Is required to respond to. nor shall any person be subject to a penalty for failure to comply with, a collection of Information

subject to the requirements of the Paperwork Reduction Act (PRA), unless that collection displays a currently valid Office of Management and Budget (OMB) control number.

Information collected using this form will not be sold.