Attachment Form 159

This document pretains to SAT-STA-20040402-00074 for Special Temporal Authority on a Satellite Space Stations filing.

IBFS_SATSTA2004040200074_370974

                                                                                                                         ORIGINAL
    READ INSTRUCTIONS CAREFULLY                                                                                                                             Approved by OMB
    BEFORE PROCEEDING                                         FEDERAL C O M M W I C A T I O N & - ~                                                                30600589
                                                                 REMITTANCE ADVICE                                               APR 0 92004                 Page   1-   o~




 PanAmSat Licensee CorD.                                                                                   1    $705.00
 (4) STREET ADDRESS LINE NO 1
 1801 K Street. N.W.
I ( 5 ) STREET ADDRESS LINE NO 2
                                                       5AT-3T.A - 2004W O2- 00074
 Suite 440
 (6) CITY                                                                                                          (7) STATE        (8)   ZIP CODE
 Washington                                                                                                         DC                          20006
 ( 9 ) DAYTIME TELEPHONE NUMBER (include area code)                                       (10)COUNTRY CODE(ifnotinUSA)
        -
  202 2924300                                                                              us
                                                                                    . ,REOUIRED
                                                            FCC REGISTRATION NUMBER lFRNI                  ~.
 ( I 1 J PAYER(FRN)                                                                        (12) FCC USB ONLY
  0005848577
                             IF MORE THAN OhE APPLICANT. USE CONTINUATION SHEETS (FORM I 5 9 E h
                COMPLETE SECTION BELOW FOR EACH SERVICE, IF MORE BOXES ARE NEEDED, USE CONT~NUATIONSHEET
 (I3)APPLICANT NAME
 PanAmSat Licensee Corn

 1801 K Street, N.W.
 (15) STREET ADDRESS LINEN0 2
 Suite 440
 (16) ClTY                                                                                                        (17) STATE        (18) ZIP CODE

 Washinnton
 (19) DAYTIME TELEPHONE NUMBER (include area code)
                                                                                                                   DC
                                                                                          (20) COUNTRY CODE (Ifnot in U S A )
                                                                                                                                               20006    -
 202-292-4300                                                                              us
                                                            FCC REGISTRATION NUMBER (FRN) REQUIRED




 (23A) CALL SIGNIOTHER ID                            (24A) PAYMENT TYPE CODE                                            (25A) QUANTITY
                                                        CRY                                                             1


                                                                                     (29A) FCC CODE 2
                                                                                   I 182004000713
 (23B) CALL SIGN/OTHER ID                            (248) PAYMENT TYPE CODE                                            (25B) QUANTITY




                                                                      SECTION D - CERTIFICATION
 CERTIFICATION STATEMENT
 I,                                             ,certify under penalty ofperjury that the foregoing and supporting information is true and correct to
 the best of my knowledge, information and belief

 SIGNATURE                                                                                                      DATE-

                                                        SECTION E     -                  PAYMENT INFORYaTlQCl

                                               MASTERCARD-                VISA-            AMEX-               DISCOVER-

ACCOUNT NUMBER                                                                                 EXPIRATION DATE

I hereby authorize the FCC to charge my credit card for the service(s)lauthoriratim herein described.

SIGNATURE                                                                                                       DATE

                                                   SEE PUBLIC BURDEN ON REVERSE                                    FCC FORM 159              FEBRUARY 2003(REVISED)



Document Created: 2004-04-29 14:29:31
Document Modified: 2004-04-29 14:29:31

© 2024 FCC.report
This site is not affiliated with or endorsed by the FCC