Application Form [pdf]

This document pretains to SAT-STA-20040924-00187 for Special Temporal Authority on a Satellite Space Stations filing.

IBFS_SATSTA2004092400187_397158

Approved by OMB 3060−0678 Date & Time Filed: Sep 24 2004 1:15:44:853PM File Number: SAT−STA−20040924−00187 Callsign: 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: STA to operate Galaxy 12 under Sep 2004 pro forma TC 1. Applicant Name: PanAmSat Licensee Corp. Phone Number: 202−292−4300 DBA Name: Fax Number: 202−292−4378 Street: 1801 K Street, N.W. E−Mail: Suite 440 City: Washington State: DC Country: USA Zipcode: 20006 − Attention: Mr Kalpak S Gude Esq 1

2. Contact Name: Joseph A. Godles, Esq. Phone Number: 202−429−4900 Company: Goldberg Godles Wiener & Wright Fax Number: 202−429−4912 Street: 1229 19th Street, NW E−Mail: jgodles@g2w2.com City: Washington State: DC Country: USA Zipcode: 20036 −2413 Contact Attorney Relationship: Legal Counsel Title: (If your application is related to an application filed with the Commission, enter the file number below.) 3. Reference File Number SATSTA2004051800096 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 125.25 WL 2

8. Description (If the complete description does not appear in this box, please go to the end of the form to view it in its entirety.) See attached exhibit. 9. By checking Yes, the undersigned certifies that neither applicant nor any other party to the application is subject Yes No 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. 10. Name of Person Signing 11. Title of Person Signing Kalpak S. Gude Vice President and Associate General Counsel 12. Please supply any need attachments. Attachment 1: STA 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). 3

FCC NOTICE REQUIRED BY THE PAPERWORK REDUCTION ACT The public reporting for this collection of information is estimated to average 2 hours per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the required data, and completing and reviewing the collection of information. If you have any comments on this burden estimate, or how we can improve the collection and reduce the burden it causes you, please write to the Federal Communications Commission, AMD−PERM, Paperwork Reduction Project (3060−0678), Washington, DC 20554. We will also accept your comments regarding the Paperwork Reduction Act aspects of this collection via the Internet if you send them to jboley@fcc.gov. PLEASE DO NOT SEND COMPLETED FORMS TO THIS ADDRESS. Remember − You are not required to respond to a collection of information sponsored by the Federal government, and the government may not conduct or sponsor this collection, unless it displays a currently valid OMB control number or if we fail to provide you with this notice. This collection has been assigned an OMB control number of 3060−0678. THE FOREGOING NOTICE IS REQUIRED BY THE PAPERWORK REDUCTION ACT OF 1995, PUBLIC LAW 104−13, OCTOBER 1, 1995, 44 U.S.C. SECTION 3507. 4


Document Created: 2019-05-24 15:40:19
Document Modified: 2019-05-24 15:40:19
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