TELEVISA_MOB-6 Amend

SUPPLEMENT submitted by TELEVISA, SA de CV

AMENDMENT APPLICATION - TELEVISA MOB-6

2014-02-28

This document pretains to SES-LIC-20140221-00094 for License on a Satellite Earth Station filing.

IBFS_SESLIC2014022100094_1037652

Approved by OMB 3060-0678 Date & Time Filed: Feb 28 2014 2:13:54:893PM File Number: SES-AMD-INTR2014-00390 FCC APPLICATION FOR SPACE AND EARTH STATION:MOD OR AMD - MAIN FORM FCC Use Only FCC 312 MAIN FORM FOR OFFICIAL USE ONLY APPLICANT INFORMATION Enter a description of this application to identify it on the main menu: AMENDMENT TELEVISA SA de CV MOB-6 1-8. Legal Name of Applicant Phone Name: TELEVISA, SA de CV Number: 2028281860 DBA Fax Name: Number: 2029555564 Street: 800 17TH STREET NW, STE 1100 E-Mail: NORM.LEVENTHAL@HKLAW.COM City: WASHINGTON State: Country: USA Zipcode: - Attention: NORMAN LEVENTHAL ESQ 9-16. Name of Contact Representative Name: NORM Phone Number: LEVENTHAL Company: HOLLAND & KNIGHT LLP Fax Number: 2028281860 Street: 800 17TH STREET, N.W. E-Mail: NORM.LEVENTHAL@HKLAW.COM SUITE 1100 City: WASHINGTON State: DC Country: USA Zipcode: 20006-3906 Attention: NORM LEVENTHAL Relationship: Legal Counsel CLASSIFICATION OF FILING 17. Choose the button next to the classification that applies to this filing for (N/A) b1. Application for License of New Station both questions a. and b. Choose only one (N/A) b2. Application for Registration of New Domestic Receive-Only Station for 17a and only one for 17b. b5. Assignment of License or Registration b6. Transfer of Control of License or Registration (N/A) b8. Application for License of New Receive-Only Station Using Non-U.S. Licensed Satellite (N/A) b9. Letter of Intent to Use Non-U.S. Licensed Satellite to Provide Service in the United States (N/A) b10. Other (Please specify) (N/A) b11. Application for Earth Station to Access a Non-U.S.satellite Not Currently Authorized to Provide the Proposed Service in the Proposed Frequencies in the United States. 17c. Is a fee submitted with this application? If No, indicate reason for fee exemption (see 47 C.F.R.Section 1.1114).

17d. Fee Classification CGV - Fixed Satellite VSAT System 18. If this filing is in reference to an 19. If this filing is an amendment to a pending application enter both fields, if this filing is a existing station, enter: modification please enter only the file number: (a) Call sign of station: (a) Date pending application was filed: (b) File number: 02/21/2014 SESLIC2014022100094 TYPE OF SERVICE 20. NATURE OF SERVICE: This filing is for an authorization to provide or use the following type(s) of service(s): Select all that apply: 21. STATUS: Choose the button next to the applicable status. Choose only one. Non-Common Carrier -U.S. licensed satellites 23. If applicant is providng INTERNATIONAL COMMON CARRIER service, see instructions regarding Sec. 214 filings. Choose one. Are these facilities: N/A -Band (4/6 GHz) b. Ku-Band (12/14 GHz) Frequency Lower: Frequency Upper: (Please specify additional frequencies in an attachment) TYPE OF STATION 25. CLASS OF STATION: Choose the button next to the class of station that applies. Choose only one. -Fixed Earth Station -Geostationary Space Station 26. TYPE OF EARTH STATION FACILITY: -Only -Only "For Space Station applications, select N/A." PURPOSE OF MODIFICATION 27. The purpose of this proposed modification is to: (Place an 'X' in the box(es) next to all that apply.) -- authorization to add new emission designator and related service -- authorization to change emission designator and related service -- authorization to increase EIRP and EIRP density -- authorization to replace antenna -- authorization to add antenna -- authorization to relocate fixed station -- authorization to change frequency(ies)

-- authorization to add frequency -- authorization to add Points of Communication (satellites & countries) -- authorization to change Points of Communication (satellites & countries) -- authorization for facilities for which environmental assessment and radiation hazard reporting is required -- authorization to change orbit location -- authorization to perform fleet management -- authorization to extend milestones -- Other (Please specify) ENVIRONMENTAL POLICY 28. Would a Commission grant of any proposal in this application or amendment have a significant environmental impact as defined by 47 CFR 1.1307? If YES, submit the statement as required by Sections 1.1308 and 1.1311 of the Commission's rules, 47 C.F.R. 1.1308 and 1.1311, as an exhibit to this application.A Radiation Hazard Study must accompany all applications for new transmitting facilities, major modifications, or RADIATION major amendments. HAZARD RPT ALIEN OWNERSHIP Earth station applicants not proposing to provide broadcast, common carrier, aeronautical en route or aeronautical fixed radio station services are not required to respond to Items 30-34. 29. Is the applicant a foreign government or the representative of any foreign government? 30. Is the applicant an alien or the representative of an alien? 31. Is the applicant a corporation organized under the laws of any foreign government? 32. Is the applicant a corporation of which more than one-fifth of the capital stock is owned of record or voted by aliens or their representatives or by a foreign government or representative thereof or by any corporation organized under the laws of a foreign country? 33. Is the applicant a corporation directly or indirectly controlled by any other corporation of which more than one-fourth of the capital stock is owned of record or voted by aliens, their representatives, or by a foreign government or representative thereof or by any corporation organized under the laws of a foreign country? 34. If any answer to questions 29, 30, 31, 32 and/or 33 is Yes, attach as an exhibit an identification of the aliens or foreign entities, their nationality, their relationship to the applicant, and the percentage of stock they own or ALIEN OWNERSHIP vote. BASIC QUALIFICATIONS 35. Does the Applicant request any waivers or exemptions from any of the Commission's Rules? If Yes, attach as an exhibit, copies of the requests for waivers or exceptions with supporting documents. 36. Has the applicant or any party to this application or amendment had any FCC station authorization or license revoked or had any application for an initial, modification or renewal of FCC station authorization, license, or construction permit denied by the Commission? If Yes, attach as an exhibit, an explination of circumstances. 37. Has the applicant, or any party to this application or amendment, or any party directly or indirectly controlling the applicant ever been convicted of a felony by any state or federal court? If Yes, attach as an exhibit, an explination of circumstances. 38. Has any court finally adjudged the applicant, or any person directly or indirectly controlling the applicant, guilty of unlawfully monopolizing or attemptiing unlawfully to monopolize radio communication, directly or indirectly, through control of manufacture or sale of radio apparatus, exclusive traffic arrangement or any other means or unfair methods of competition?If Yes, attach as an exhibit, an explanation of circumstances 39. Is the applicant, or any person directly or indirectly controlling the applicant, currently a party in any pending matter referred to in the preceding two items? If yes, attach as an exhinit, an explanation of the circumstances. 40. If the applicant is a corporation and is applying for a space station license, attach as an exhibit the names, address, and citizenship of those stockholders owning a record and/or voting 10 percent or more of the Filer's voting stock and the percentages so held. In the case of fiduciary control, indicate the beneficiary(ies) or class of beneficiaries. Also list the names and addresses of the officers and directors of the Filer.

41. 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. 42a. Does the applicant intend to use a non-U.S. licensed satellite to provide service in the United States? If Yes, answer 42b and attach an exhibit providing the information specified in 47 C.F.R. 25.137, as appropriate. If No, proceed to question 43. 42b. What administration has licensed or is in the process of licensing the space station? If no license will be issued, what administration has coordinated or is in the process of coordinating the space station? 43. Description. (Summarize the nature of the application and the services to be provided). Televisa is a television company in Mexico City which uses these facilities to cover sporting events in the U.S. for transmission to Mexico City 43a. Geographic Service Rule Certification By selecting A, the undersigned certifies that the applicant is not subject to the geographic service or geographic coverage requirements specified in 47 C.F.R. Part 25. By selecting B, the undersigned certifies that the applicant is subject to the geographic service or geographic coverage requirements specified in 47 C.F.R. Part 25 and will comply with such requirements. By selecting C, the undersigned certifies that the applicant is subject to the geographic service or geographic coverage requirements specified in 47 C.F.R. Part 25 and will not comply with such requirements because it is not feasible as a technical matter to do so, or that, while technically feasible, such services would require so many compromises in satellite design and operation as to make it economically unreasonable. A narrative description and technical analysis demonstrating this claim are attached. --> CERTIFICATION The Applicant waives any claim to the use of any particular frequency or of the electromagnetic spectrum as against the regulatory power of the United States because of the previous use of the same, whether by license or otherwise, and requests an authorization in accordance with this application. The applicant certifies that grant of this application would not cause the applicant to be in violation of the spectrum aggregation limit in 47 CFR Part 20. All statements made in exhibits are a material part hereof and are incorporated herein as if set out in full in this application. The undersigned, individually and for the applicant, hereby certifies that all statements made in this application and in all attached exhibits are true, complete and correct to the best of his or her knowledge and belief, and are made in good faith. 44. Applicant is a (an): (Choose the button next to applicable response.) 45. Name of Person Signing 46. Title of Person Signing William Aguirre Ballesteros General Satellite Director of Televisa 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). SATELLITE EARTH STATION AUTHORIZATIONS FCC Form 312 - Schedule B:(Technical and Operational Description) FOR OFFICIAL USE ONLY Location of Earth Station Site E1: Site Identifier: CONUS E5. Call Sign: NEW

E2: Contact Name William Aguirre Ballesteros E6. Phone Number: 525552247161 E3. Street: 1001 Russell Street E7. City: Multiple E8. County: USA E4. State E9. Zip Code E10. Area of Operation: CONUS E11. Latitude: 0 ° 0 ' 0.0 " E12. Longitude: 0 ° 0 ' 0.0 " E13. Lat/Lon Coordinates are: NAD-27 NAD-83 E14. Site Elevation (AMSL): 0.0 meters E15. If the proposed antenna(s) operate in the Fixed Satellite Service (FSS) with geostationary satellites, do(es) the proposed antenna(s) comply with the antenna gain patterns specified in Section 25.209(a) and (b) as demonstrated by the manufacturer's qualification measurement? If NO, provide as a technical analysis showing Yes No compliance with two-degree spacing policy. E16. If the proposed antenna(s) do not operate in the Fixed Satellite Service (FSS), or if they operate in the Fixed Satellite Service (FSS) with non-geostationary satellites, do(es) the proposed antenna(s) comply with the antenna gain patterns specified in Section 25.209(a2) and (b) as demonstrated by the manufacturer's qualification Yes No measurements? E17. Is the facility operated by remote control? If YES, provide the location and telephone number of the control point. Yes E18. Is frequency coordination required? If YES, attach a frequency coordination report as Yes E19. Is coordination with another country required? If YES, attach the name of the country Yes (ies) and plot of coordination contours as E20. FAA Notification - (See 47 CFR Part 17 and 47 CFR part 25.113(c)) Where FAA notification is required, have you attached a copy of a completed FCC Form 854 and/or the FAA's study regarding the potential hazard of the structure to aviation? Yes FAILURE TO COMPLY WITH 47 CFR PARTS 17 AND 25 WILL RESULT IN THE RETURN OF THIS APPLICATION. POINTS OF COMMUNICATION Satellite Name:OTHER | OTHER | If you selected OTHER, please enter the following: E21. Common Name: ALSAT E22. ITU Name: E23. Orbit Location: E24. Country: USA POINTS OF COMMUNICATION (Destination Points) E25. Site Identifier: CONUS E26. Common Name:ALSAT E27. Country: Mexico ANTENNA E32. E41/42. Antenna Gain Transmint E28. E29. E30. E31. Site ID Antenna Id Quantity Antenna and/or Recieve(____dBi at Manufacturer Model Size _____GHz) TVSA CONUS 1 NORSAT NS-3200 1.0 40.5 dBi at 11.85 MOB-6 TVSA CONUS 1 NORSAT NS-3200 1.0 42.0 dBi at 14.15 MOB-6 E38. Total E33/34. E35. Above E36. E37. Building Input Power E39. Maximum E40. Total E28. Diameter Ground Above Sea Height Above Antenna Height EIRP for al Antenna at antenna Minor/Major Level Level Ground Level Above Rooftop carriers Id flange (meters) (meters) (meters) (meters) (meters) (dBW) (Watts) TVSA 1.0/1.0 3.0 18.0 10.0 200.0 1.5 64.0 MOB-6 FREQUENCY

E28. E43/44. E45. E46. Antenna E48. Maximum E49. Maximum ERIP E47. Emission Antenna Frequency T/R Polarization EIRP per Carrier Density per Carrier Designator Id Bands(MHz) Mode (H,V,L,R) (dBW) (dBW/4kHz) TVSA Horizontal and 14000 14500 T 20MOG2F 53.77 -21.4 MOB-6 Vertical E50. Modulation and Services QPSK-SCPC Digital carrier transmitting video and audio service TVSA Horizontal and 14000 14500 T 40MOG2F 56.8 -21.4 MOB-6 Vertical E50. Modulation and Services QPSK-SCPC Digital carrier transmitting video and audio service FREQUENCY COORDINATION E56. E58. E57. E59. E60. Earth Earth E52/53. E54/55. Range of Antenna Antenna Maximum E28. Station Station Antenna E51. Satellite Frequency Satellite Arc Azimuth Elevation Azimuth Elevation EIRP Density Orbit Type Limits Eastern/Western Angle Angle toward the Id Angle Angle (MHz) Limit Eastern Western Horizon Eastern Western Limit Limit (dBW/4kHz) Limit Limit TVSA 14000 Geostationary 83.0/99.2 128.0 28.0 218.0 59.0 21.4 MOB-6 14500 REMOTE CONTROL POINT LOCATION E61. Call Sign E66. Phone Number NOTE: Please enter the callsign of the controlling station, not the callsign for which this application is being filed. E62. Street Address E63. City E68. County E67/68. E64. Zip State/Country Code / 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.

Radiation Hazard Report Page 1 of 6 Analysis of Non-Ionizing Radiation for a 1.0-Meter Earth Station System This report analyzes the non-ionizing radiation levels for a 1.0-meter earth station system. The analysis and calculations performed in this report comply with the methods described in the FCC Office of Engineering and Technology Bulletin, No. 65 first published in 1985 and revised in 1997 in Edition 97-01. The radiation safety limits used in the analysis are in conformance with the FCC R&O 96-326. Bulletin No. 65 and the FCC R&O specifies that there are two separate tiers of exposure limits that are dependant on the situation in which the exposure takes place and/or the status of the individuals who are subject to the exposure. The Maximum Permissible Exposure (MPE) limits for persons in a General Population/Uncontrolled environment are shown in Table 1. The General Population/Uncontrolled MPE is a function of transmit frequency and is for an exposure period of thirty minutes or less. The MPE limits for persons in an Occupational/Controlled environment are shown in Table 2. The Occupational MPE is a function of transmit frequency and is for an exposure period of six minutes or less. The purpose of the analysis described in this report is to determine the power flux density levels of the earth station in the far-field, near-field, transition region, between the subreflector or feed and main reflector surface, at the main reflector surface, and between the antenna edge and the ground and to compare these levels to the specified MPEs. Table 1. Limits for General Population/Uncontrolled Exposure (MPE) Frequency Range (MHz) Power Density (mW/cm2) 30-300 0.2 300-1500 Frequency (MHz)*(0.8/1200) 1500-100,000 1.0 Table 2. Limits for Occupational/Controlled Exposure (MPE) Frequency Range (MHz) Power Density (mW/cm2) 30-300 1.0 300-1500 Frequency (MHz)*(4.0/1200) 1500-100,000 5.0 Table 3. Formulas and Parameters Used for Determining Power Flux Densities Parameter Symbol Formula Value Units Antenna Diameter D Input 1.0 m Antenna Surface Area Asurface π D2 / 4 0.79 m2 Feed Flange Diameter Dfa Input 10.0 cm Area of Feed Flange Afa π Dfa 2/4 78.54 cm2 Frequency F Input 14250 MHz Wavelength λ 300 / F 0.021053 m Transmit Power P Input 200.00 W Antenna Gain (dBi) Ges Input 42.0 dBi Antenna Gain (factor) G 10Ges/10 15848.9 n/a Pi π Constant 3.1415927 n/a Antenna Efficiency η Gλ2/(π2D2) 0.71 n/a

Radiation Hazard Report Page 2 of 6 1. Far Field Distance Calculation The distance to the beginning of the far field can be determined from the following equation: Distance to the Far Field Region Rff = 0.60 D2 / λ (1) = 28.5 m The maximum main beam power density in the far field can be determined from the following equation: On-Axis Power Density in the Far Field Sff = G P / (4 π Rff 2) (2) = 310.549 W/m2 = 31.055 mW/cm2 2. Near Field Calculation Power flux density is considered to be at a maximum value throughout the entire length of the defined Near Field region. The region is contained within a cylindrical volume having the same diameter as the antenna. Past the boundary of the Near Field region, the power density from the antenna decreases linearly with respect to increasing distance. The distance to the end of the Near Field can be determined from the following equation: Extent of the Near Field Rnf = D2 / (4 λ) (3) = 11.9 m The maximum power density in the Near Field can be determined from the following equation: Near Field Power Density Snf = 16.0 η P / (π D2) (4) = 724.958 W/m2 = 72.496 mW/cm2 3. Transition Region Calculation The Transition region is located between the Near and Far Field regions. The power density begins to decrease linearly with increasing distance in the Transition region. While the power density decreases inversely with distance in the Transition region, the power density decreases inversely with the square of the distance in the Far Field region. The maximum power density in the Transition region will not exceed that calculated for the Near Field region. The power density calculated in Section 1 is the highest power density the antenna can produce in any of the regions away from the antenna. The power density at a distance Rt can be determined from the following equation: Transition Region Power Density St = Snf Rnf / Rt (5) = 72.496 mW/cm2

Radiation Hazard Report Page 3 of 6

Radiation Hazard Report Page 4 of 6 4. Region between the Feed Assembly and the Antenna Reflector Transmissions from the feed assembly are directed toward the antenna reflector surface, and are confined within a conical shape defined by the type of feed assembly. The most common feed assemblies are waveguide flanges, horns or subreflectors. The energy between the feed assembly and reflector surface can be calculated by determining the power density at the feed assembly surface. This can be determined from the following equation: Power Density at the Feed Flange Sfa = 4000 P / Afa (6) = 10185.916 mW/cm2 5. Main Reflector Region The power density in the main reflector is determined in the same manner as the power density at the feed assembly. The area is now the area of the reflector aperture and can be determined from the following equation: Power Density at the Reflector Surface Ssurface = 4 P / Asurface (7) = 1018.592 W/m2 = 101.859 mW/cm2 6. Region between the Reflector and the Ground Assuming uniform illumination of the reflector surface, the power density between the antenna and the ground can be determined from the following equation: Power Density between Reflector and Ground Sg = P / Asurface (8) = 254.648 W/m2 = 25.465 mW/cm2

Radiation Hazard Report Page 5 of 6 7. Summary of Calculations Table 4. Summary of Expected Radiation levels for Uncontrolled Environment Calculated Maximum Radiation Power Density Level Region (mW/cm2) Hazard Assessment 1. Far Field (Rff = 28.5 m) Sff 31.055 Potential Hazard 2. Near Field (Rnf = 11.9 m) Snf 72.496 Potential Hazard 3. Transition Region (Rnf < Rt < Rff) St 72.496 Potential Hazard 4. Between Feed Assembly and Sfa 10185.916 Potential Hazard Antenna Reflector 5. Main Reflector Ssurface 101.859 Potential Hazard 6. Between Reflector and Ground Sg 25.465 Potential Hazard Table 5. Summary of Expected Radiation levels for Controlled Environment Calculated Maximum Radiation Power Density Region Level (mW/cm2) Hazard Assessment 1. Far Field (Rff = 28.5 m) Sff 31.055 Potential Hazard 2. Near Field (Rnf = 11.9 m) Snf 72.496 Potential Hazard 3. Transition Region (Rnf < Rt < Rff) St 72.496 Potential Hazard 4. Between Feed Assembly and Sfa 10185.916 Potential Hazard Antenna Reflector 5. Main Reflector Ssurface 101.859 Potential Hazard 6. Between Reflector and Ground Sg 25.465 Potential Hazard It is the applicant's responsibility to ensure that the public and operational personnel are not exposed to harmful levels of radiation. 8. Conclusions 9. Conclusions Based on this analysis it is concluded that the FCC RF Guidelines have been exceeded in the specific regions of Tables 4 and 5. The applicant proposes to comply with the Maximum Permissible Exposure (MPE) limits of 1 mW/cm2 for the Uncontrolled areas and the MPE limits of 5 mW/cm2 for the Controlled areas by one or more of the following methods: Means of Compliance Uncontrolled Areas The area around this antenna will be roped off while this system is in operation. The general public will not have access to areas within ½ diameters from the edge of the antenna.

Radiation Hazard Report Page 6 of 6 Since one diameter removed from the main beam of the antenna or ½ diameter removed from the edge of the antenna the RF levels are reduced by a factor of 100 or 20 dB. None of the areas exceeding the MPE levels will be accessible by the general public. Radiation hazard signs will be posted while this earth station is in operation. The applicant will ensure that no buildings or other obstacles will be in the areas that exceed the MPE levels. Means of Compliance Controlled Areas The earth station’s operational personnel will not have access to the areas that exceed the MPE levels while the earth station is in operation. The transmitters will be turned off during antenna maintenance.

EXHIBIT 1 Televisa S.A. de C.V. FCC Form 312 Questions 30-34 February 2014 1 of 1 ALIEN OWNERSHIP The applicant, Televisa S.A. de C.V., is a Mexican corporation the majority of whose corporate officers and directors are Citizens of the United Mexican States (“Mexico). Televisa is owned by Grupo Televisa, S.A.B. a Mexican Corporation based in Mexico City. Grupo Televisa is owned by public shareholders located worldwide. Such ownership by non-U.S. entities is not a bar to the grant of a Termporary Fixed Earth Station authorization. Indeed, Bay City Television, Inc., a sister company, also ultimately owned by Grupo Televisa, itself currently holds such authorizations as well as a 325 permit to transmit local news and other programming electronically to Station XETV(TV), Tijuana, B.C., Mexico (File No. 325-RWL-20130430-00001). Neither Televisa nor Grupo Televisa are representatives of a foreign government. #24263138_v1

Agency Tracking ID:PGC2470893 Authorization Number:281939 Successful Authorization -- Date Paid: 2/28/14 FILE COPY ONLY!! READ INSTRUCTIONS FEDERAL COMMUNICATIONS COMMISSION APPROVED BY OMB CAREFULLY BEFORE 3060-059 PROCEEDING REMITTANCE ADVICE FORM 159 PAGE NO 1 OF 1 SPECIAL USE (1) LOCKBOX #979093 FCC USE ONLY SECTION A - Payer Information (3) TOTAL AMOUNT PAID (dollars and cents) (2) PAYER NAME (if paying by credit card, enter name exactly as it appears on your card) HOLLAND & KNIGHT LLP $180.00 (4) STREET ADDRESS LINE NO. 1 800 17TH STREET, STE. 1100 (5) STREET ADDRESS LINE NO. 2 TELECOM-C. NAFTALIN (6) CITY (7) STATE (8) ZIP CODE WASHINGTON DC 20006-3906 (9) DAYTIME TELEPHONE NUMBER (INCLUDING AREA CODE) (10) COUNTRY CODE (IF NOT IN U.S.A.) 202-9553000 x7040 US FCC REGISTRATION NUMBER (FRN) AND TAX IDENTIFICATION NUMBER (TIN) REQUIRED (11) PAYER (FRN) (12) FCC USE ONLY 0004148995 IF PAYER NAME AND THE APPLICANT NAME ARE DIFFERENT, COMPLETE SECTION B IF MORE THAN ONE APPLICANT, USE CONTINUATION SHEETS (FORM 159-C) (13) APPLICANT NAME TELEVISA, SA de CV (14) STREET ADDRESS LINE NO. 1 800 17TH STREET NW, STE 1100 (15) STREET ADDRESS LINE NO. 2 (16) CITY (17) STATE (18) ZIP CODE WASHINGTON - (19) DAYTIME TELEPHONE NUMBER (INCLUDING AREA CODE) (20) COUNTRY CODE (IF NOT IN U.S.A.) 2028281860 US FCC REGISTRATION NUMBER (FRN) AND TAX IDENTIFICATION NUMBER (TIN) REQUIRED (21) APPLICANT (FRN) (22) FCC USE ONLY 0016686628 COMPLETE SECTION C FOR EACH SERVICE, IF MORE BOXES ARE NEEDED, USE CONTINUATION SHEET (23A) FCC Call Sign/Other ID (24A) Payment Type Code(PTC) (25A) Quantity CGV 1 (26A) Fee Due for (PTC) (27A) Total Fee FCC Use Only $180.00 $180.00 (28A) FCC CODE 1 (29A) FCC CODE 2 IB2014000390 (23B) FCC Call Sign/Other ID (24B) Payment Type Code(PTC) (25B) Quantity (26B) Fee Due for (PTC) (27B) Total Fee FCC Use Only (28B) FCC CODE 1 (29B) FCC CODE 2


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Document Modified: 2014-02-28 14:20:08
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