Attachment Form 159 CGX

This document pretains to SES-STA-20091201-01515 for Special Temporal Authority on a Satellite Earth Station filing.

IBFS_SESSTA2009120101515_783294

READ INSTRUCTIONS CAREFULLY Approved by OMB BEFORE PROCEEDING FEDERAL COMMUNICATIONS COMMISSION 30600589 REMITTANCE ADVICE Page No_* of2 FORM 159 (1) LOCKBOX # [~~SPECIAL USE ONLY FCC USE ONLY SECTION A — PAYER INFORMATION (2) PAYER NAME (if paying by credit card enter name exactly as it appears on the card) (3) TOTAL AMOUNT PAID (U.S. Dollars and cents) TeleCommunication Systems, Inc. $175.00 (4) STREET ADDRESS LINE NO.1 275 West Street (5) STREET ADDRESS LINE NO.2 (6 CYy (7) STATE (8) Zip cCODE Annapolis MD 21401 (9) DAYTIME TELEPHONE NUMBER (include area code) (10) COUNTRY CODE (if not in U.S.A.) 410—349—7097 FCC REGISTRATION NUMBER (FRN) REQUIRED (11) PAYER (FRN) (12)FCC U-SE ONLY 0005049846 mnmanommnnochhsarannsmstnccnrmmacnremmennammnzenmemmmmn IF MORE THAN ONE APPLICANT, USE CONTINUATION SHEETS (FORM 159—C) COMPLETE SECTION BELOW FOR EACH SERVICE, IF MORE BOXES ARE NEEDED, USE CONTINUATION SHEET (13) APPLICANT NAME TeleCommunication Systems, Inc. (14) STREET ADDRESS LIN-E:Z NO.1 275 West Street (15) STREET ADDRESS LINE NO. 2 (16)CITY (17) STATE (18) ZIP CODE |Annapolis MD 21401 (19) DAYTIME TELEPHONE NUMBER (include area code) (20) COUNTRY CODE (if not in U.S.A.) 410—349—7097 nrommmmenensmnemnnmmmnmensiovemmmmnmemmmnennmensmenin FCC REGISTRATION NUMBER (FRN) REQUIRED (21) APPLICANT(FRN) (22)FCC USE ONLY 0005049846 COMPLETE SECTION C FOR EACH SERVICE, IF MORE BOXES ARE NEEDED, USE CONHINUATION SHEET mo—o——mepaco——ccmmmmmommmmvemmmenmmmmmnmmmncmus rommennmmmem (23A) CALL SIGN/OTHER ID (24A) PAYMENT TYPE CODE (25A) QUANTITY E070086 CGX 1 cummuenmume (26A) FEE DUE FOR (PTC) (27A) TOTAL FEE FCC USE ONLY $175.00 $175.00 (28A) FCC CODEIT (29A) FCC CODE 2 memevmenmnmermnemmmnmenms emmmnmmn mm (23B) CALL SIGN/OTHER ID (24B) PAYMENT TYPE CODE (25B) QUANTITY 1 mmnnemmnegn (26B) FEE DUE FOR (PTC) (278) TOTAL FEE FCC USE ONLY (28B)FCC CODE I (29B)FCC CODE 2 SECTION D — CERTIFICATION beconmmnmnmmemnmesmannememmmmmmmenmmmmmarmmnam CERTIFICATION STATEMENT ., _X m obkns «SYeoyilt certify under penalty ofperjury that the foregoing and supporting information is true and correct to the best ofmy knowledge, information and belief. L SIGNATURE /é/, ho e pate_ /4 /2 [ 09 SECTIONE — CREDIT CARD PAYMENT INFORMATION MASTERCARD VISA AMEX ZC DISCOVER accountnuuomerr_3 794 #ISG 14 !1_O00 EXPIRATION DATE O Zl 1(4 T hereby authorize the FCC to charge my credit card for the service(s)/authorization herein described. SIGNATURE V/(_//é PA /7(-,/(/@((’ BATe tb 1{ L‘{I of enr mm im nrimnna an nnunrnen Tan ranii:co TBoortra nV anna


Document Created: 2019-04-26 10:05:55
Document Modified: 2019-04-26 10:05:55
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