Application Form

This document pretains to SES-STA-20040730-01084 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 703 755 6733
BT Americas Inc. 703 755- 6740
11440 Commerce Park Drive E-Mail: [email protected]
Suite 5041
Reston VA
USA 20191 -
Regulatory Compliance Manager Other
3. Reference File Number
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
08/15/2004
7. CityFlushing 8. Latitude
(dd mm ss.s h)
40 45 0.3 N
9. State NY 10. Longitude
(dd mm ss.s h)
73 51 6.2 W
11. Please supply any need attachments.
Attachment 1: 312 Schedule B Attachment 2: Rad Haz Study Attachment 3:
12. Description. STA request for operation of 2 1.5 meter Ku-Band temporary fixed antennae to cover the USTA tennis tournament in Flushing, NY August 15 thru September 15, 2004.
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
Linda J. Cicco
15. Title of Person Signing
Reg. Compliance Manager
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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