Application Form

This document pretains to SAT-STA-20040128-00007 for Special Temporal Authority on a Satellite Space Stations filing.

Approved by OMB
3060-0678

FEDERAL COMMUNICATIONS COMMISSION
APPLICATION FOR SPACE STATION SPECIAL TEMPORARY AUTHORITY


FOR OFFICIAL USE ONLY

APPLICANT INFORMATION


Enter a description of this application to identify it on the main menu:
1. Applicant
SES Americom, Inc. 609-987-4000
609-987-4233
Four Research Way [email protected]
Princeton NJ
USA 08540 -6684
Scott B. Tollefsen
2. Contact
Karis A. Hastings 202-637-5767
Hogan & Hartson L.L.P. 202-637-5910
555 Thirteenth Street, NW [email protected]
Washington DC
USA 20004 -1109
Legal Counsel
(If your application is related to an application filed with the Commission, enter the file number below.)
3. Reference File Number
4a. Is a fee submitted with this application?
If Yes, complete and attach FCC Form 159.

If No, indicate reason for fee exemption (see 47 C.F.R.Section 1.1114).
Governmental Entity Noncommercial educational licensee
Other(please explain):

4b. Fee Classification CRY - Space Station (Geostationary)
5. Type Request
Change Station Location Extend Expiration Date Other
6. Temporary Orbit Location
7. Requested Extended Expiration Date
8. Description See Attachment 1
9. By checking Yes, the undersigned certifies that neither applicant nor any other party to the application is subject to a denial of Federal benefits that includes FCC benefits pursuant to Section 5301 of the Anti-Drug Act of 1988, 21 U.S.C. Section 862, because of a conviction for possession or distribution of a controlled substance. See 47 CFR 1.2002(b) for the meaning of "party to the application" for these purposes. Yes No
10. Name of Person Signing
Scott B. Tollefsen
11. Title of Person Signing
Vice President & Associate General Counsel
12. Please supply any need attachments.
Attachment 1: Att. 1 Attachment 2: Attachment 3:
WILLFUL FALSE STATEMENTS MADE ON THIS FORM ARE PUNISHABLE BY FINE AND / OR IMPRISONMENT
(U.S. Code, Title 18, Section 1001), AND/OR REVOCATION OF ANY STATION AUTHORIZATION
(U.S. Code, Title 47, Section 312(a)(1)), AND/OR FORFEITURE (U.S. Code, Title 47, Section 503).



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