Application Form [pdf]

This document pretains to SES-STA-20050214-00176 for Special Temporal Authority on a Satellite Earth Station filing.

IBFS_SESSTA2005021400176_417255

                                                                                                       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:
STA for E950078
    1. Applicant

              Name:        Tampa Bay Television Inc   Phone Number:                 813−354−2828
              DBA Name:                               Fax Number:                   813−873−2828
              Street:      4045 North Himes Ave       E−Mail:                       pwilson@wfts.com


              City:        Tampa                      State:                        FL
              Country:     USA                        Zipcode:                      33607       −
              Attention:   Mr Michael Doback




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    2. Contact

                 Name:         Kenneth C. Howard, Jr.               Phone Number:                       202−861−1580
                 Company:      Baker & Hostetler LLP                Fax Number:                         202−861−1783
                 Street:       1050 Connecticut Avenu, NW           E−Mail:                             khoward@bakerlaw.com
                               Suite 1100
                 City:         Washington                           State:                               DC
                 Country:      USA                                  Zipcode:                            20036         −5304
                 Contact       Partner                              Relationship:                        Legal Counsel
                 Title:


    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   CGX − Fixed Satellite Transmit/Receive Earth Station
    5. Type Request

        Use Prior to Grant                                Change Station Location                             Other


    6. Requested Use Prior Date


    7. City                                                                    8. Latitude
                                                                               (dd mm ss.s h)   0   0   0.0




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    9. State                                                                   10. Longitude
                                                                               (dd mm ss.s h)     0   0   0.0
    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.)
        STA is requested to operate facilities authorized for temporary fixed earth satellite
        station E950078 which has expired. A new application for these facilities will be filed.




    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
      Michael Doback                                                             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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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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Document Created: 2019-04-23 09:41:57
Document Modified: 2019-04-23 09:41:57

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