Application Form [pdf]

This document pretains to SES-STA-20100608-00680 for Special Temporal Authority on a Satellite Earth Station filing.

IBFS_SESSTA2010060800680_821477

                                                                                                             Approved by OMB
                                                                                                                    3060−0678

                               APPLICATION FOR EARTH STATION SPECIAL TEMPORARY AUTHORITY



APPLICANT INFORMATIONEnter a description of this application to identify it on the main menu:
Further Extension of STA for Earth Station KA258 to Perform TT&C for the Intelsat 16 Satellite
    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:                 susan.crandall@intelsat.com
                           3400 International Drive, N.W.
              City:        Washington                       State:                   DC
              Country:     USA                              Zipcode:                20008        −3006
              Attention:   Susan H Crandall




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    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:                               susan.crandall@intelsat.com
                               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 SESMFS2010012900134 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


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    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:                                      Attachment 3:


    12. Description.   (If the complete description does not appear in this box, please go to the end of the form to view it in its entirety.)
        Intelsat North America LLC herein requests a further 30−day extension −− through July 12,
        2010 −− of the Special Temporary Authority previously granted Intelsat to use its
        Clarksburg, Maryland Ku−band earth station −− call sign KA258 −− to provide telemetry,
        tracking and command services for the Intelsat 16 satellite at its permanent location of



    13. By checking Yes, the undersigned certifies that neither applicant nor any other party to the application is               Yes            No
    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.


    14. Name of Person Signing                                                 15. Title of Person Signing
      Susan H. Crandall                                                          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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The public reporting for this collection of information is estimated to average 2 hours per response, including the time for reviewing instructions,
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DO NOT SEND COMPLETED FORMS TO THIS ADDRESS.

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.




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12. Description

Intelsat North America LLC herein requests a further 30−day extension −− through July 12, 2010 −−
of the Special Temporary Authority previously granted Intelsat to use its Clarksburg, Maryland Ku−
band earth station −− call sign KA258 −− to provide telemetry, tracking and command services for
the Intelsat 16 satellite at its permanent location of 58.10 W.L.




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Document Created: 2019-05-16 00:23:11
Document Modified: 2019-05-16 00:23:11

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