Application Form [pdf]

This document pretains to SES-MOD-20131113-01118 for Modification on a Satellite Earth Station filing.

IBFS_SESMOD2013111301118_1020742

Approved by OMB 3060−0678 Date & Time Filed: Nov 10 2013 3:02:29:290PM File Number: SES−MOD−INTR2013−02466 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: WJFW E7642 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 Street: 9145 Ellis Road E−Mail: michele.tully@ussi.org City: Melbourne State: FL Country: USA Zipcode: 32904− Attention: Michele Tully Relationship: Same 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. b3. Amendment to a Pending Application b4. Modification of License or Registration a1. Earth Station b5. Assignment of License or Registration a2. Space Station b6. Transfer of Control of License or Registration b7. Notification of Minor Modification (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 (N/A) b12. Application for Database Entry b13. Amendment to a Pending Database Entry Application b14. Modification of Database Entry 2

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: E7642 SESRWL2004082401221 3

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:

TYPE OF STATION 25. CLASS OF STATION: Choose the button next to the class of station that applies. Choose only one. a. Fixed Earth Station b. Temporary−Fixed Earth Station c. 12/14 GHz VSAT Network d. Mobile Earth Station e. Geostationary Space Station f. Non−Geostationary Space Station g. Other (please specify) 26. TYPE OF EARTH STATION FACILITY: Transmit/Receive Transmit−Only Receive−Only N/A "For Space Station applications, select N/A." 5


Document Created: 2019-04-21 07:03:42
Document Modified: 2019-04-21 07:03:42
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