Attachment Form 159

This document pretains to ITC-STA-20091117-00490 for Special Temporal Authority on a International Telecommunications filing.

IBFS_ITCSTA2009111700490_781147

FCC:Success:Form 159 - PRINTABLE VERSION file:///Users/ericgros-dubois/Desktop/printed159_success.cfm.html Remittance ID:1693722 Authorization Number:253961 Successful Authorization -- Date Paid: 11/17/09 FILE COPY ONLY!! READ INSTRUCTIONS FEDERAL COMMUNICATIONS COMMISSION APPROVED BY OMB CAREFULLY BEFORE 3060-059 PROCEEDING REMITTANCE ADVICE SPECIAL USE FORM 159 PAGE NO 1 OF 1 FCC USE ONLY (1) LOCKBOX #979093 SECTION A - Payer Information (2) PAYER NAME (if paying by credit card, enter name exactly as it appears on your card) (3) TOTAL AMOUNT PAID (dollars and cents) Jeffrey D Katz $1015.00 (4) STREET ADDRESS LINE NO. 1 4733 Bethesda Avenue (5) STREET ADDRESS LINE NO. 2 Suite 345 (6) CITY (7) STATE (8) ZIP CODE Bethesda MD 20814 (9) DAYTIME TELEPHONE NUMBER (INCLUDING AREA CODE) (10) COUNTRY CODE (IF NOT IN U.S.A.) 301-9132948 US FCC REGISTRATION NUMBER (FRN) AND TAX IDENTIFICATION NUMBER (TIN) REQUIRED (11) PAYER (FRN) (12) FCC USE ONLY 0017374059 IF PAYER NAME AND THE APPLICANT NAME ARE DIFFERENT, COMPLETE SECTION B IF MORE THAN ONE APPLICANT, USE CONTINUATION SHEETS (FORM 159-C) (13) APPLICANT NAME Jeffrey D Katz (14) STREET ADDRESS LINE NO. 1 4733 Bethesda Avenue (15) STREET ADDRESS LINE NO. 2 Suite 345 (16) CITY (17) STATE (18) ZIP CODE Bethesda MD 20814 (19) DAYTIME TELEPHONE NUMBER (INCLUDING AREA CODE) (20) COUNTRY CODE (IF NOT IN U.S.A.) 301-9132948 US FCC REGISTRATION NUMBER (FRN) AND TAX IDENTIFICATION NUMBER (TIN) REQUIRED (21) APPLICANT (FRN) (22) FCC USE ONLY 0017374059 COMPLETE SECTION C FOR EACH SERVICE, IF MORE BOXES ARE NEEDED, USE CONTINUATION SHEET (23A) FCC Call Sign/Other ID (24A) Payment Type Code(PTC) (25A) Quantity N/A CUT 1 (26A) Fee Due for (PTC) (27A) Total Fee FCC Use Only $1,015.00 $1015.00 (28A) FCC CODE 1 (29A) FCC CODE 2 N/A N/A 1 of 2 11/17/09 11:43 AM

FCC:Success:Form 159 - PRINTABLE VERSION file:///Users/ericgros-dubois/Desktop/printed159_success.cfm.html (23B) FCC Call Sign/Other ID (24B) Payment Type Code(PTC) (25B) Quantity (26B) Fee Due for (PTC) (27B) Total Fee FCC Use Only (28B) FCC CODE 1 (29B) FCC CODE 2 2 of 2 11/17/09 11:43 AM


Document Created: 0500-05-27 00:00:00
Document Modified: 0500-05-27 00:00:00
© 2024 FCC.report
This site is not affiliated with or endorsed by the FCC