Listener complaint. A statement that is signed and dated by the listener and contains the following information:
(1) The complainant's full name, address, and phone number;
(2) A clear, concise, and accurate description of the location where interference is alleged or predicted to occur;
(3) A statement that the complainant listens over-the-air to the desired station at least twice a month; and
(4) A statement that the complainant has no legal, financial, employment, or familial affiliation or relationship with the desired station.