Application Form SES-STA-20030919-01269

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:

STA to Install, Test, and Operate Disaster Recovery Sites Prior to Grant.

1. Applicant

Name:	SES Americom, Inc.	Phone Number:	609-987-4062
DBA Name:		Fax Number:	609-987-4260
Street:	Four Research Way	E-Mail:	[email protected]

City:	Princeton	State:	NJ
Country:	USA	Zipcode:	08540 -6684
Attention:	James R. Barker

2. Contact

Name:	James Barker	Phone Number:	609-987-4062
Company:	SES Americom, Inc.	Fax Number:	609-987-4260
Street:	Four Research Way	E-Mail:	[email protected]

City:	Princeton	State:	NJ
Country:	USA	Zipcode:	08540 -6684
Contact Title:	Terrestrial Systems Specialist	Relationship:	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

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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