Application Form [pdf]

This document pretains to SES-MOD-20131113-01035 for Modification on a Satellite Earth Station filing.

IBFS_SESMOD2013111301035_1020806

Approved by OMB 3060−0678 Date & Time Filed: Nov 10 2013 4:56:31:740PM File Number: SES−MOD−INTR2013−02502 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: WNNE E7419 1−8. Legal Name of Applicant Name: United Service Source Inc Phone Number: 321−723−5395 x135 DBA Fax Number: 321−727−3107 Name: Street: 9145 Ellis Road E−Mail: michele.tully@ussi.org City: West Melbourne State: FL Country: USA Zipcode: 32904 − Attention: Michele Tully 1

9−16. Name of Contact Representative Name: Michele Tully Phone Number: 321−723−5395 x135 Company: United Service Source Inc Fax Number: 321−727−3107 a1. Earth Station 9145 Ellis Road Street: E−Mail: michele.tully@ussi.org a2. Space Station CLASSIFICATION OF FILING

17c. 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): 17d. Fee Classification CGX − Fixed Satellite Transmit/Receive Earth Station 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: E7419 SESRWL2004070700965 3


Document Created: 2019-04-23 13:48:20
Document Modified: 2019-04-23 13:48:20
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