Application Form SAT-STA-20040924-00189

Application Form

This document pretains to SAT-STA-20040924-00189 for Special Temporal Authority on a Satellite Space Stations filing.

Approved by OMB
3060-0678

Date & Time Filed: Sep 24 2004 1:19:14:073PM
File Number: SAT-STA-20040924-00189
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 PAS-5 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

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:	[email protected]

City:	Washington	State:	DC
Country:	USA	Zipcode:	20036 -2413
Contact Title:	Attorney	Relationship:	Legal Counsel

(If your application is related to an application filed with the Commission, enter the file number below.)
3. Reference File Number SATSTA2004051800098

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
166 EL

7. Requested Extended Expiration Date

8. Description See attached exhibit.

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

10. Name of Person Signing
Kalpak S. Gude

11. Title of Person Signing
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).

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 [email protected]. 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.