Application Form

This document pretains to SES-STA-20030919-01269 for Special Temporal Authority on a Satellite Earth Station filing.

Approved by OMB
3060-0678
APPLICATION FOR EARTH STATION SPECIAL TEMPORARY AUTHORITY


APPLICANT INFORMATION

Enter a description of this application to identify it on the main menu:

SES Americom, Inc. 609-987-4062
609-987-4260
Four Research Way [email protected]
Princeton NJ
USA 08540 -6684
James R. Barker

James Barker 609-987-4062
SES Americom, Inc. 609-987-4260
Four Research Way E-Mail: [email protected]
Princeton NJ
USA 08540 -6684
Terrestrial Systems Specialist Same
3. Reference File Number SESMOD2003091201246
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 CGV - Fixed Satellite VSAT System
5. Type Request
Use Prior to Grant Change Station Location Other
6. Requested Use Prior Date
09/19/2003
7. CityMultiple 8. Latitude
(dd mm ss.s h)
0 0 0.0
9. State 10. Longitude
(dd mm ss.s h)
0 0 0.0
11. Please supply any need attachments.
Attachment 1: E900007ST Attachment 2: Attachment 3:
12. Description. SES Americom wishes to install, test and operate a small number of VSAT sites prior to the grant of pending application SES-MOD-20030912-01246.
13. 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. Yes No
14. Name of Person Signing
Nancy J. Eskenazi
15. Title of Person Signing
Vice President and General Counsel
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).



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