Application Form

This document pretains to SES-STA-20040315-00374 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:

BT Americas Inc. 703-755-6733
703-755-6740
11440 Commerce Park Drive [email protected]
Suite 5041
Reston VA
USA 20191 -
Ms Linda J Cicco

Linda J. Cicco 571-203-6816
BT Americas Inc. 571-203-6889
11911 Freedom Drive E-Mail: [email protected]
11th Floor
Reston VA
USA 20190 -
Regulatory Compliance Manager Same
3. Reference File Number SESLIC2003031400343
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
03/15/2004
7. CityCONUS 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: Attachment 2: Schedule B Attachment 3: RAD HAZ STUDY
12. Description. Applicant requests authority for immediate operations of facilities requested in underlying modification of license application to VSAT License E030053in order to meet customer demands for testing and demonstration purposes locally and at the NAB in Las Vegas, Nevada.
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
A. Sheba Chacko
15. Title of Person Signing
Asst. Secretary
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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