Application Form [pdf]

This document pretains to SES-STA-20050106-00016 for Special Temporal Authority on a Satellite Earth Station filing.

IBFS_SESSTA2005010600016_412103

                                                                                                        Approved by OMB
                                                                                                               3060−0678

                               APPLICATION FOR EARTH STATION SPECIAL TEMPORARY AUTHORITY



APPLICANT INFORMATIONEnter a description of this application to identify it on the main menu:
CWCI VSAT Network STA
    1. Applicant

              Name:        Central Wisconsin         Phone Number:                  715−421−8174
                           communications, Inc.
              DBA Name:                              Fax Number:                    715−421−6039
              Street:      440 East Grand Avenue     E−Mail:                        lysne@wctc.net
                           8045
              City:        Rapids                    State:                         WI
              Country:     USA                       Zipcode:                       54495       −8045
              Attention:   Mr Jamey Lysne




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    2. Contact

                 Name:        Bill Swart                         Phone Number:                         703−917−9882
                 Company:     Skjei Telecom, Inc.                Fax Number:                           703−917−0098
                 Street:      7777 Leesburg Pike                 E−Mail:                               bill.swart@skjeitelecom.com
                              #315N
                 City:        Falls Church                       State:                                VA
                 Country:     USA                                Zipcode:                              22043       −2403
                 Contact      Systems Engineer                   Relationship:                         Engineer
                 Title:


    3. Reference File Number SESLICINTR200403462
    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
          01/12/2005
    7. CityArpin                                                            8. Latitude
                                                                            (dd mm ss.s h)   44   30    58.7   N




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    9. State   WI                                                              10. Longitude
                                                                               (dd mm ss.s h)     89   57    0.5   W
    11. Please supply any need attachments.
    Attachment 1:                                     Attachment 2:                                      Attachment 3:


    12. Description.   (If the complete description does not appear in this box, please go to the end of the form to view it in its entirety.)
        A STA is requested to allow performance testing and verification of proper earth station
        operation and to allow preliminary operation of the referenced VSAT network during such
        time that the permanent license application is being processed. This VSAT network will
        assist medical institutions in implementing network diversity to support HIPAA



    13. By checking Yes, the undersigned certifies that neither applicant nor any other party to the application is               Yes            No
    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.


    14. Name of Person Signing                                                 15. Title of Person Signing
      Mr. Jamey Lysne                                                            Director of Operations
               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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THE FOREGOING NOTICE IS REQUIRED BY THE PAPERWORK REDUCTION ACT OF 1995, PUBLIC LAW 104−13, OCTOBER
1, 1995, 44 U.S.C. SECTION 3507.




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12. Description

A STA is requested to allow performance testing and verification of proper earth station operation
and to allow preliminary operation of the referenced VSAT network during such time that the
permanent license application is being processed. This VSAT network will assist medical
institutions in implementing network diversity to support HIPAA requirements and will provide
disaster recovery network capabilities to financial institutions.




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Document Created: 2019-05-02 15:08:28
Document Modified: 2019-05-02 15:08:28

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