Application Form

This document pretains to SES-STA-20050106-00016 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:

Central Wisconsin communications, Inc. 715-421-8174
715-421-6039
440 East Grand Avenue [email protected]
8045
Rapids WI
USA 54495 -8045
Mr Jamey Lysne

Bill Swart 703-917-9882
Skjei Telecom, Inc. 703-917-0098
7777 Leesburg Pike E-Mail: [email protected]
#315N
Falls Church VA
USA 22043 -2403
Systems Engineer Engineer
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
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. 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.
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
Mr. Jamey Lysne
15. Title of Person Signing
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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