Application Form

This document pretains to SES-STA-20090911-01153 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:

Intelsat North America LLC 202-944-7848
202-944-7870
c/o Intelsat Corporation [email protected]
3400 International Drive, N.W.
Washington DC
USA 20008 -3006
Susan H Crandall

Intelsat North America LLC 202-944-7848
202-944-7870
c/o Intelsat Corporation E-Mail: [email protected]
3400 International Drive, N.W.
Washington DC
USA 20008 -3006
Legal Counsel
(If your application is related to an application filed with the Commission, enter either the file number or the IB Submission ID of the related application. Please enter only one.)
3. Reference File Number
or Submission ID
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. CityClarksburg 8. Latitude
(dd mm ss.s h)
39 13 7.4 N
9. State MD 10. Longitude
(dd mm ss.s h)
77 16 10.9 W
11. Please supply any need attachments.
Attachment 1: STA Request Attachment 2: Exhibit A Attachment 3: Exhibit B
12. Description. Intelsat North America LLC herein requests a grant of Special Temporary Authority for 30 days, from October 30, 2009 through November 28, 2009, to use its Clarksburg, Maryland C-band earth station, call sign KA275, to provide launch and early orbit phase services for the Intelsat 14 satellite that is expected to be launched on October 30, 2009.
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
Susan H. Crandall
15. Title of Person Signing
Asst. General Counsel, Intelsat Corporation
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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