Attachment Exhibit D

This document pretains to SES-LIC-20140725-00619 for License on a Satellite Earth Station filing.

IBFS_SESLIC2014072500619_1054950

Submitted: 06/20/2014 at 17:37:05 File Number: A0907712 FCC Form 854 Approved by OMD – 3060-0139 Main Form See instructions for public burden estimate Application for Antenna Structure Registration Purpose of Filing 1) Enter the application purpose: (NE ) AM – Amendment of a Pending Application NE – Registration of a New Antenna Structure AU – Administrative Update NT – Required Construction/Alteration Notification CA – Cancellation of an Antenna Structure Registration OC – Ownership Change DI – Notification of an Antenna Structure Dismantlement RE – Registration of a Replacement Antenna Structure DU – Request for a Duplicate Antenna Structure Registration WD – Withdrawal of a Pending Application MD – Modification of a Antenna Structure Registration 2a) If the answer to 1 is AU, CA, DI, DU, MD, NT, OC or RE, provide the FCC Antenna Structure FCC ASR Number: Registration (ASR) Number. 2b) If the answer to 1 is AM or WD, provide the File Number of the pending application on file. File Number: 2c) If the answer to 1 is MD or NT, provide the date the Antenna Structure was constructed or the date it Date: was last altered (mm/dd/yyyy). 2d) If the answer to 1 is DI, provide the date the Antenna Structure was dismantled (mm/dd/yyyy). Date: Antenna Structure Ownership Information 3) Select one of the entity types: ( ) Individual ( ) Unincorporated Association ( ) Trust ( ) Government Entity ( ) Corporation ( X ) Limited Liability Company ( ) General Partnership ( ) Limited Partnership ( ) Consortium ( ) Limited Liability Partnership ( ) Other: ____________________________________ 4) FCC Registration Number (FRN): 5) Assignor FCC Registration Number (FRN): 0021818133 6) First Name (if individual): MI: Last Name: Suffix: 7) Legal Entity Name (if not an individual): The Alaska Wireless Network, LLC 8) Attention To: 9) P.O. Box: And/Or Cindy L Hall 10a) Street Address 1: 10b) Street Address 2: 2550 Denali Street, Suite 1000 11) City: 12) State: 13) Zip Code: Anchorage AK 99503 14) Telephone Number (xxx-xxx-xxxx): 15) Fax Number: (xxx-xxx-xxxx): (907) 868-5615 (907) 868-9817 16) E-mail Address: gcilicensemanager@gci.com FCC Form 854 – Page 1 June 2012 Version 1.1

Contact Representative Information 17) First Name (if individual): MI: Last Name: Suffix: Cindy L Hall 18) Business Name: The Alaska Wireless Network, LLC 19) Attention To: 20) P.O. Box And/Or Regulatory, License Manager 21a) Street Address 1: 21b) Street Address 2: 2550 Denali Street, Suite 1000 22) City: 23) State: 24) Zip Code: Anchorage AK 99503 25) Telephone Number (xxx-xxx-xxxx): 26) Fax Number: (xxx-xxx-xxxx): (907) 868-5615 (907) 868-9817 27) E-mail Address: chall2@gci.com Antenna Structure Information 28a) Latitude (DD-MM-SS.S): 28b) North or South: 57- 03- 01.7 North 29a) Longitude (DDD-MM-SS.S): 29b) East or West: 135- 18- 32.3 West 30) Street Address or Geographic Location: 31) City: SE portion of Lot A, Dawson Subdivision Sitka 32) County: 33) State: 34) Zip Code: SITKA ALASKA 99835 35) Elevation of site above mean sea level (meters): 15.2 meters 36) Overall height above ground level (AGL) of the supporting structure without appurtenances: 10.2 meters 37) Overall height above ground level (AGL) of the antenna structure including all appurtenances: 10.2 meters 38) Overall height above mean sea level (add items 35 and 37 together): 25.4 meters 39a) Enter the type of structure on which the antenna will be mounted: ( BANT ) B – Building NNLTANN – Lattice Tower Array BANT – Building with Antenna on Top NNMTANN – Monopole Array BMAST – Building with Mast PIPE – Any type of Pipe BPIPE – Building with Pipe POLE – Any type of Pole BPOLE – Building with Pole RIG – Oil or Other Type of Rig BRIDG – Bridge SIGN – Any type of Sign or Billboard BTWR – Building with Tower SILO – Any type of Silo GTOWER – Guyed Structure Used For Communication Purposes STACK – Smoke Stack LTOWER – Lattice Tower TANK – Any type of Tank (water, gas, etc.) MAST – Mast TREE – When used as a support for an antenna MTOWER – Monopole UPOLE – Utility Pole/Tower used to provide service NNGTANN – Guyed Tower Array (electric, telephone, etc.) 39b) Number of Towers in Array: 39c) Position of this Tower in the Array: 40a) Array Center Latitude (DD-MM-SS.S): 40b) North or South 41a) Array Center Longitude (DDD-MM-SS.S): 41b) East or West: FCC Form 854 – Page 2 June 2012 Version 1.1

Proposed Marking and/or Lighting 42) Enter the proposed marking and/or lighting: ( 1 ) Tier 1 - No Lights Tier 2 – No Red Steady Lights Tier 3 – Red Steady Lights 1) None 4) FAA Style B (L-856) 7) FAA Style E (L-864/L-865/L-810) 2) Paint Only 5) FAA Style D (L-865) 8) FAA Style F (L-856/L-864/L-810) 3) Other ____________________ 6) FAA Style C (L-856/L-865) 9) FAA Style A (L-864/L-810) FAA Notification 43) FAA Study Number: 44) Date Issued: Environmental Compliance 45) Does the applicant request a waiver of the Commission’s rules for environmental notice prior to ( No ) Yes or No construction due to an emergency situation? 46a) If the answer to 45 is No, is another federal agency taking responsibility for environmental review of ( No ) Yes or No the Antenna Structure? 46b) If the answer to 46a is Yes, indicate why: ( ) 1 or 2 1) The Antenna Structure is on Federal Land and the landholding agency is taking responsibility for the environmental review of the Antenna Structure. 2) Another federal agency has agreed with the FCC in writing to take responsibility for the environmental review of the Antenna Structure. 46c) If the answer to 46a is Yes, provide the name of the federal agency taking responsibility for the Name: environmental review of the Antenna Structure. 47) If the answers to 45 and 46a are No, provide the National Notice Date for the application to be Date: posted on the FCC’s website (mm/dd/yyyy). 06/23/2014 48) Is the applicant submitting an environmental assessment? ( No ) Yes or No 49) Does the applicant certify that grant of Authorizations at this location would not have a significant ( ) Yes or No environmental effect pursuant to Section 1.1307 of the FCC’s rules? 50) If the answer to 49 is Yes, select the basis for this certification. ( ) 1, 2, 3, 4 1) The construction is exempt from environmental notification (other than due to another agency’s review) and it does not fall within one of the categories in Section 1.1307(a) or (b) of the FCC’s rules? 2) The construction is exempt from environmental notification due to another agency’s review, and the other agency has issued a Finding of No Significant Impact. 3) The environmental notification has been completed, and the FCC has notified the applicant that an Environmental Assessment is not required under Section 1.1307(c) or (d) of the FCC’s rules, and the Construction does not fall within one of the categories in Section 1.1307(a) or (b) of the FCC’s rules. 4) The FCC has issued a Finding of No Significant Impact. 51) If the answer to 50 is 3 or 4, enter the date that Local Notice was provided (mm/dd/yyyy). Date: FCC Form 854 – Page 3 June 2012 Version 1.1

Certification Statements 1) The applicant certifies that all statements made in this application and in the exhibits, attachments, or documents incorporated by reference are material, are part of this application, and are true, complete, correct, and made in good faith. 2) The applicant certifies that neither the applicant nor any other party to the application is subject to a denial of Federal benefits pursuant to Section 5301 of the Anti-Drug Abuse Act of 1988, 21 U.S.C. § 862, because of a conviction for possession or distribution of a controlled substance. See Section 1.2002(b) of the rules, 47 CFR § 1.2002(b), for the definition of "party to the application" as used in this certification Signature (Typed or Printed Name of Party Authorized to Sign) 52) First Name: MI: Last Name: Suffix: Jimmy Sipes 53) Title: VP, Network Services & Chief Engineer 54) Signature: 55) Date: Jimmy Sipes Jun 20, 2014 WILLFUL FALSE STATEMENTS MADE ON THIS FORM OR ANY ATTACHMENTS ARE PUNISHABLE BY FINE AND/OR IMPRISONMENT (U.S. Code, Title 18, Section 1001) AND/OR REVOCATION OF ANY STATION LICENSE OR CONSTRUCTION PERMIT (U.S. Code, Title 47, Section 312(a)(1)), AND/OR FORFEITURE (U.S. Code, Title 47, Section 503). FCC Form 854 – Page 4 June 2012 Version 1.1


Document Created: 2014-07-25 10:05:11
Document Modified: 2014-07-25 10:05:11
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