2012 AFFIDAVIT FOR PERFORMANCE
Affiant, first being sworn on oath deposes and states that this affidavit is made on his/her personal knowledge and/or based upon a review
of the logs and records of the radio station hereafter identified and that he/she could competently testify as follows. Affiant is an adult, and
he/she is employed by the radio station in the employment position hereafter described. Program(s) broadcast unedited in its entirety,
including national announcements, on the station(s) indicated below on the following month, day(s) and time(s) each week for the month
indicated. With the electronic or physical signature below, affiant certifies that the information contained in this affidavit is true and correct
and that the programs listed above were broadcast as stated. Further affiant sayeth naught.
MONTH
CITY &
STATE
Do you stream our shows on your
station website(s)?
___ YES ___ NO
________________________, 2012
Did the show(s) run in entirety each
If no, please explain in NOTES below.
___ YES ___ NO
_____________________________
PLEASE LIST CALLS, DAY & TIME.
EX) WWKK-AM SUN 7:30 AM
___________________________________
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___________________________________
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Name of Station Official
Title of Station Official
______________________________
______________________________
EMAIL TO: affidavits@mediatracks.com
NOTES
FAX TO: 847-299-9501