Application Form

This document pretains to SES-STA-20040331-00494 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:

Scripps Howard Broadcasting Company 513-977-3000
513-977-3728
312 Walnut Street [email protected]
Cincinnati OH
USA 45202 -
Michael Doback

Michael Doback 248 827 9490
Scripps Howard Broadcasting Company 248 827 9491
20777 West Ten Mile Rd. E-Mail: [email protected]
Southfield MI
USA 48037 -
Vice President Engineering Engineer
3. Reference File Number SESLIC2004032900470
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 CGX - Fixed Satellite Transmit/Receive Earth Station
5. Type Request
Use Prior to Grant Change Station Location Other
6. Requested Use Prior Date
04/06/2004
7. CityKansas City 8. Latitude
(dd mm ss.s h)
0 0 0.0
9. State MO 10. Longitude
(dd mm ss.s h)
0 0 0.0
11. Please supply any need attachments.
Attachment 1: Attachment 2: Drug Statement Attachment 3:
12. Description. Use prior to grant of IB2004000689 filed March 29, 2004 is requesed so that testing of a new temporary fixed earth station can be accomplished and so that the system can be used to gather news and special event programing on an as needed basis for use by KSHB-TV, KSHB-DT, KMCI-TV and KMCI-DT. Full information of the truck is in SES-LIC-20040329-00470 along with an RF Statement.
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
Michael Doback
15. Title of Person Signing
Vice President Engineering
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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