=r HEARST TELEVISION, IncPOLITICALIISSUE ADVERTISING INQUIRYIREQUEST PUBLIC FILE FORM i 1r.@amsr Thisjirrmmustbe completedasto allrequests, both (1) lobe usedbyoron behalf of a candidate for public twice, or (2) involving a controversial issue afpubllc importance (including political and legislative matters where there ls no "use" by a legally qualyied candidate). 17::3 form and its attachments are to be kept in the station 's Public Inspection ile for a period of two years. Note: Forisa?ue where there isg "use" odvertiseonentdoesrmt relate to anypolltical or legislativenurtter cfmtional bnportanoe, the station may elect to only complete Questions I -10 1 Date and time of request: Tuesdgg 4pm 2 Name ofthe pemm making request: Ronde Levine 3 Agency (if any): Target Entergses 4 Address of agency: 15260 Ventura Blvd. #1240 Shennan Oaks. CA 91403 5 Telephone number of agency: 818 905-0005 6 Name of candidate or description of issue: Government Int_gr_ig Fund 7 Name of candidates authorized committee or name ofissue ad sponsor: Government Fund 8 Address of candidaws committee or issue ad sponsor contact: 208 East State Street, 3rd Floor Columbus, Ohlo 43215 9 Telephone number ofcandidate's committee or issue ad sponsor contact: 614 306-3690 I0 Ifthe purchaser is not an individual, list the chiefeiceeutive ctiicexs or members ofthe executive committee or oftheboerdofdirectors ofthe entityorcntitiesthet is/are paying Ecrtbe advertising ('mcluding treasurerofcandidate's committee, if candidate ad) (use additioml pages ifnecessary): Name: Tom Norris Title: Chalnnan Name: Tom Norris Title: Treasurer Name: Title: 12 Dates requested (use additional pages if necessary): 3rd Quarter 2012 I3 of time requested (use additional pages ifnecessary): l4 Length of spot/program time requested (use additional pages ifnecessuy): :30 I All dayparrs I5 Requestmade: In (ifin writing,attach andretain) Orallyi 16 Disposition of request: Granted Not Granted lfmorgranted, state reason orreasans in space below. lfdenied in writing, attach aadretain. {1"granied, attach contract, invoice andsehedule ofdate andlinre on which the ad(r) actuallyaired when available) 17 I/'the to a candidate (candidate or issue ad), please complete Qvesdms 18 -23. IS Name ofcandidate (ifdiihtent from Question 6 above): l-9 Political party of candidate: I 20 Ofliee For which candidate is running: 21 it gg Federal Ofice? State Otice? Local Ofnce? 22 Election 23 Date ofeleetionz . behalfq'acandldaie, please complete Questions 24-26. 24 Request for documentation that candidate Yes No is legally qualified. (Attach any written documentation received.) 25 Date Political Disclosure Statement submitted to requestor: Yea No Campaign Reform Act (BCRA) Certification? (attadn copy) (attach copy) Signature of Person Receiving Request On Behalf of Station