Application Form

This document pretains to SES-STA-20100519-00631 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:

ETERNAL WORD TELEVISION NETWORK, INC. 205-271-2900
205-271-2953
5817 OLD LEEDS ROAD [email protected]
BIRMINGHAM AL
USA 35210 -
Mr JIM CHARLES

Basil F. Pinzone, Jr. 440 463 3928
Pinzone Engineering Group, Inc. 440 338 4494
10142 Fairmount Road E-Mail: [email protected]
Newbury OH
USA 44065 -9531
Basil F. Pinzone, Jr. Engineer
(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 SESLIC2010051900611 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): Applicant is a Non-Profit Organization. IRS Determination Attached

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
05/22/2010
7. CityHanceville 8. Latitude
(dd mm ss.s h) 34 3 30.5 N
9. State AL 10. Longitude
(dd mm ss.s h) 86 41 40.8 W
11. Please supply any need attachments.
Attachment 1: Non-Profit IRS Let Attachment 2: Attachment 3:
12. Description. Routine Application for Ku Uplink, Domestic Satellite Service to the Permitted List. Video w/Associated Audio, Audio, Data, Telemetry. Request Use Prior for a SPECIAL EVENT on Sunday 5/23/2010.
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
Mr. Michael P. Warsaw 		15. Title of Person Signing
CEO-President
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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