Attachment Form 159

This document pretains to SAT-STA-20040319-00081 for Special Temporal Authority on a Satellite Space Stations filing.

IBFS_SATSTA2004031900081_368767

Approved by OMB READ INSTRUCTIONS CAREFULLY FEDERAL COMMUNICATIONS COMMISSION 30604589 BEFORE PROCEEDING REMITTANCE ADVICE Page 1- 0; ... _ . Mintz. Levin. Cohn, Ferris, Glovskv &-PoD~O I $145.00 (4) STREET ADDRESS LINE NO.1 701 Pennsvlvania Avenue, N.W. ( 5 ) STREET ADDRESS LINE NO. 2 Suite 900 (6) CITY (7) STATE ( 8 )ZIP CODE Washinnton DC DC 20004 (9) DAYTIME TELEPHONE NUMBER (include area code) (IO) COUNTRY CODE(ifnotinU.S.A.) 202-434-7300 F C C REGISTRATION NUMBER (FRN) REQUIRED - Rainbow DBS Companv LLC (14)STREETADDRESS L I N E N 0 I 200 Jericho Quadranale (1 ti) STREET ADDRESS LINE NO. 2 (1 6) CITY (17) STATE (18) ZIP CODE Jericho NY 11 753 (1 9) DAYTIME TELEPHONE NUMBER (mclude area code) I (20)COUNTRYCODE(ifnotinUS A . ) 516-803-2569 w-r- RRCISTRATION - ._ ........ . I J M R K R I F R N ~REOUIRED .N (21) APPLICANT(FRN) 0006-8593-75 C O M P L E T E S E C T I O N C FOR EACH SERVICE, I F M( (23A) CALL SIGNiOTHER ID (24A) PAYMENT TYPE CODE (25A) QUANTITY DBS8701 MGD 1 (23B) CALL SIGN/OTHER ID (24B) PAYMENT TYPE CODE (25B) QUANTITY I SECTION D - CERTIFICATION C TIFIC T I 0 S T I ?%fl&. L3 QMENT 10 ,certify under penalty ofperjury that the foregoing and supprtlng mfonnation Is true and correct to SIGNATURE c DATE- s ~ ’ ) / L ~ o f- I I SECTION E - C R E D I T CARD PAYMENT INFORMATION MASTERCARD- VISA--- AMEX-- DISCOVER--_ ACCOUNT NUMBER EXPIRATION DATE I hereby authorize the FCC to charge mycreht card for the service(s)/authorizahcn herem described SIGNATURE DATE SEE PUBLIC BURDEN ON REVERSE FCC FORM 159 FEBRUARY 2003(REVISED)


Document Created: 2004-04-12 14:27:17
Document Modified: 2004-04-12 14:27:17
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