Application Form [pdf]

This document pretains to SAT-STA-20100217-00028 for Special Temporal Authority on a Satellite Space Stations filing.

IBFS_SATSTA2010021700028_801736

                                                                                                      Approved by OMB
                                                                                                             3060−0678

Date & Time Filed: Feb 17 2010 4:33:28:996PM
File Number: SAT−STA−20100217−00028
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:
Sirius XM Haiti STA Extension Request
1. Applicant

           Name:         Sirius XM Radio Inc.               Phone Number:      212−584−5100
           DBA Name:                                        Fax Number:        212−584−5353
           Street:       1221 Avenue of the Americas        E−Mail:            james.blitz@siriusxm.com
                         36th Floor
           City:         New York                           State:             NY
           Country:       USA                               Zipcode:           10020       −
           Attention:    Mr. James Blitz




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2. Contact

             Name:         Jennifer Hindin                      Phone Number:                        202−719−4975
             Company:      Wiley Rein LLP                       Fax Number:                          202−719−7207
             Street:       1776 K Street, NW                    E−Mail:                              jhindin@wileyrein.com


             City:         Washington                           State:                                DC
             Country:        USA                                Zipcode:                             20006      −
             Attention:    Ms. Jennifer Hindin                  Relationship:                        Legal Counsel


(If your application is related to an application filed with the Commission, enter either the file number or the IB Submission ID of the related
application. Please enter only one.)
3. Reference File Number SATSTA2010011900012 or Submission ID
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
                                                                                2010−03−19 00:00:00.0




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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.)
       Sirius XM requests a 30−day extension of the special temporary authority it received on
       January 18, 2010 related to its provision of service to Haiti to assist with relief
       efforts following the recent earthquake.




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
Mr. James S. Blitz                                                          Vice President, Regulatory Counsel
12. Please supply any need attachments.
    Attachment 1: Extension Request                 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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Remember − You are not required to respond to a collection of information sponsored by the Federal government, and the government may not
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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.




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Document Created: 2019-04-13 20:46:18
Document Modified: 2019-04-13 20:46:18

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