Application Form SES-STA-20050106-00016

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:

CWCI VSAT Network STA

1. Applicant

Name:	Central Wisconsin communications, Inc.	Phone Number:	715-421-8174
DBA Name:		Fax Number:	715-421-6039
Street:	440 East Grand Avenue	E-Mail:	[email protected]
	8045
City:	Rapids	State:	WI
Country:	USA	Zipcode:	54495 -8045
Attention:	Mr Jamey Lysne

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:	[email protected]
	#315N
City:	Falls Church	State:	VA
Country:	USA	Zipcode:	22043 -2403
Contact Title:	Systems Engineer	Relationship:	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

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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Remember - You are not required to respond to a collection of information sponsored by the Federal government, and the government may not conduct or sponsor this collection, unless it displays a currently valid OMB control number or if we fail to provide you with this notice. This collection has been assigned an OMB control number of 3060-0678.

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.