Application Form

This document pretains to SES-STA-20050629-00842 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:

FiberSat Global Services, Inc. 818-678-2020
818-678-2041
20640 Bahama St. [email protected]
Chatsworth CA
USA 91311 -
Mr. Ravi Patel

David Keir 202-429-8970
Leventhal Senter & Lerman PLLC 202-293-7783
2000 K Street, N.W. E-Mail: [email protected]
Suite 600
Washington DC
USA 20006 -
David Keir Legal Counsel
3. Reference File Number SESLICINTR200501432
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
07/05/2005
7. CityChatsworth 8. Latitude
(dd mm ss.s h)
34 14 20.0 N
9. State CA 10. Longitude
(dd mm ss.s h)
118 35 8.0 W
11. Please supply any need attachments.
Attachment 1: Explanation Attachment 2: App - Schedule B Attachment 3:
12. Description. Request to operate HUB portion of Ku-band VSAT network as a stand-alone 9 meter fixed-satellite earth station prior to action on pending VSAT application.
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
Ravi Patel
15. Title of Person Signing
President & COO
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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