Fillable PB-19 Performance Tax

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PB-19 Performance Tax

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  • 9 check-boxes
  • 31 other fields

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Political Broadcast Agreement Form for
Non-Candidate/Issue Advertisements (PB-19)
Political Broadcast Agreement Form for
Non-Candidate/Issue Advertisements (PB-19)
This form may serve as a model agreement for the sale of political broadcast advertising time and
to facilitate compliance with the Federal Communications Commission’s (FCC) record retention
requirements. Broadcasters seeking information on how the FCC’s political broadcast rules and
record retention requirements apply to their specic circumstances should seek the advice of
their own attorney.
Please note:
You will be prompted to save this form after each entry of your electronic signature. Make sure
to re-save the form if you enter any information after entering your electronic signature.
Produced and published by NAB’s Legal department. Copyright 2020 National Association
of Broadcasters.
Reproduction or publication of the contents, in whole or in part, without express permission is
prohibited. No liability is assumed with respect to the use of the information contained herein.
A companion to this form is NAB’s Political Broadcast Catechism. To assist with your understanding
of the political advertising rules, an all-new Political Advertising Primer course will become
available via Broadcast Education in March 2020.
Broadcast Education is NAB’s home for online educational offerings, including live and on-demand
webcasts, podcasts and certicate courses. For more information, visit education.nab.org.
NAB members have access to an array of member tools and benets. To access additional
member tools, please visit nab.org/MemberTools.
ISSUE (Non-candidate) ADVERTISEMENT
AGREEMENT FORM
I, ____________________________, hereby request station time as follows: See Order for proposed
schedule and charges. See Invoice for actual schedule and charges.
Check one:
Ad “communicates a message relating to any political matter of national importance” by referring to
(1) a legally qualied candidate for federal ofce; (2) an election to federal ofce; (3) a national legislative
issue of public importance (e.g., health care legislation, IRS tax code, etc.); or (4) a political issue that is the
subject of controversy or discussion at the national level.
Ad does NOT communicate a message relating to any political matter of national importance (e.g., relates
only to a state or local issue).
ALL QUESTIONS/BLOCKS MUST BE COMPLETED
Station time requested by:
Agency name:
Address:
Contact: Phone number: Email:
Name of adv
ertiser/sponsor (list entity’s full legal name as disclosed to the Federal Election Commission [for federal
committees] with no acronyms; name must match the sponsorship ID in ad):
Name:
Address:
Contact: Phone number: Email:
Station is authorized to announce the time as paid for by such person or entity.
List
ALL of the chief executive officers or members of the executive committee or board of directors or other governing
group(s) of the advertiser/sponsor (Use separate page if necessary.):
By sig
ning below, advertiser/sponsor represents that those listed above are the only executive officers, members of the
executive committee and board of directors or other governing group(s).
If ad refers to a federal candidate(s) or federal election, list ALL of the following:
N/A
Name(s) of every candidate referred to:
Ofce(s) sought by such candidate(s) (no acronyms or abbreviations):
Date of election:
Clearly identify EVERY political matter of national importance referred to in the
N/A
ad (no acronyms); use separate page if necessary:
✔
National Association of Broadcasters
n/a
National Association of Broadcasters
1 M Street SE Washington, DC 20003
Michelle Lehman
(202)429-5350
Curtis LeGeyt, President and Chief Executive Officer
Shawn Donilon, EVP, Government Relations
Michelle Lehman, Chief of Staff and EVP, Public Affairs
Tea Gennaro, Chief Financial Officer and EVP, Finance and Administration
For further information, please visit https://www.nab.org/about/departments/default.asp.
✔
Local Radio Freedom Act, H. Con. Res 33 and S. Con. Res 9
American Music Fairness Act, H.R. 4130
THIS STATION DOES NOT DISCRIMINATE OR PERMIT DISCRIMINATION ON THE BASIS OF RACE OR ETHNICITY
IN THE PLACEMENT OF ADVERTISING.
The advertiser/sponsor agrees to indemnify and hold harmless the station for any damages or liability, including reasonable
attorney’s fees, which may arise from the broadcast of the above-requested advertisement(s). For the above-requested
ad(s), the advertiser/sponsor also agrees to prepare a script, transcript or tape, which will be delivered to the station by the
log deadlines outlined in the station’s disclosure statement.
Advertiser/Sponsor Station Representative
Signature: Signature:
Name: Name:
Date of Request to Purchase Ad Time: Date of Station Agreement to Sell Time:
TO BE COMPLETED BY STATION ONLY
Ad submitted to station?
Yes No
Date ad received:
If only one officer, executive committee member or director is listed above, station should ask the advertiser/sponsor
in writing if there are any other ofcers, executive committee members or directors, maintain records of inquiry and
update this form if additional ofcers, members or directors are provided.
Disposition:
Accepte
d
Accepted IN PART (e.g., ad not received to determine content)*
Rejected – provide reason (optional):
*Upload partially accepted form, then promptly upload updated nal form when complete.
Date and nature of follow-ups, if any:
Contract #: Station Call Letters: Date Received/Requested:
Est. #: Station Location: Run Start and End Dates:
For national issue ads only (not required for state/local issue ads):
Upload order, this disclosure form and invoice (or traffic system print-out) or other material reflecting this transaction
to the OPIF or use this space to document schedule of time purchased, when spots actually aired, the rates charged
and the classes of time purchased (including date, time, class of time and reasons for any make-goods or rebates) or
attach separately. If station will not upload the actual times spots aired until an invoice is generated, the name of a
contact person who can provide that information immediately should be placed in the “Terms and Disclosures” folder
in the OPIF.
Note: Must have separate PB-19 forms (or the equivalent, e.g., addendums) for each version of the ad (i.e., for every ad with differing copy).
Michelle Lehman
March 21, 2022
✔
✔
n/a
n/a
n/a
N/A. Free time. There are no rates, invoice, or classes of time related to this run of spots. See either the attached for information on
when the spots aired or this station will upload this information as soon as it is available.
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PB-19 Performance Tax

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Completed 25 March 2022

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