Application Form SES-STA-20091230-01638

Application Form

This document pretains to SES-STA-20091230-01638 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:

STA for Earth Station KA258 to Provide LEOP for the Intelsat 16 Satellite Launch

1. Applicant

Name:	Intelsat North America LLC	Phone Number:	202-944-7848
DBA Name:		Fax Number:	202-944-7870
Street:	c/o Intelsat Corporation	E-Mail:	[email protected]
	3400 International Drive, N.W.
City:	Washington	State:	DC
Country:	USA	Zipcode:	20008 -3006
Attention:	Susan H Crandall

2. Contact

Name:	Intelsat North America LLC	Phone Number:	202-944-7848
Company:		Fax Number:	202-944-7870
Street:	c/o Intelsat Corporation	E-Mail:	[email protected]
	3400 International Drive, N.W.
City:	Washington	State:	DC
Country:	USA	Zipcode:	20008 -3006
Attention:	Susan H. Crandall	Relationship:	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 6.6 N

9. State MD

10. Longitude
(dd mm ss.s h) 77 16 15.3 W

11. Please supply any need attachments.

Attachment 1: STA Request

Attachment 2: Exhibit A

Attachment 3:

12. Description. Intelsat North America LLC herein requests a grant of Special Temporary Authority for 30 days, from February 4, 2010 through March 5, 2010, to use its Clarksburg, Maryland Ku-band earth station, call sign KA258, to provide LEOP services for the Intelsat 16 satellite that is expected to be launched on February 4, 2010. The LEOP period is expected to last approximately ten days.

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
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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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.