Application Form [pdf]

This document pretains to SAT-STA-20170328-00056 for Special Temporal Authority on a Satellite Space Stations filing.

IBFS_SATSTA2017032800056_1203100

Approved by OMB 3060−0678 Date & Time Filed: Mar 28 2017 6:50:57:753PM File Number: SAT−STA−20170328−00056 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: Terra Bella additional earth stations STA 1. Applicant Name: Terra Bella Technologies Inc. Phone Number: 720−238−5634 DBA Name: Fax Number: Street: 1061 Terra Bella Avenue E−Mail: craig@terrabella.com City: Mountain View State: CA Country: USA Zipcode: 94043 − Attention: Craig Scheffler 1

2. Contact Name: Stephanie Selmer Phone Number: 202−346−1404 Company: Google Inc. Fax Number: 202−346−1101 Street: 25 Massachusetts Avenue NW E−Mail: selmer@google.com Ninth Floor City: Washington State: DC Country: USA Zipcode: 20001 − Attention: 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 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 CXW − Space Station (Non−Geostationary) 5. Type Request Change Station Location Extend Expiration Date Other 6. Temporary Orbit Location 7. Requested Extended Expiration Date 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.) Terra Bella requests 60−day temporary authority to communicate with three additional earth stations. See Exhibit A for more information. 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 Camie Hackson Engineering Director 12. Please supply any need attachments. Attachment 1: Exhibit A 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 PRA@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: 2019-04-13 03:40:56
Document Modified: 2019-04-13 03:40:56
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