Application Form [pdf]

This document pretains to SES-STA-20110728-00865 for Special Temporal Authority on a Satellite Earth Station filing.

IBFS_SESSTA2011072800865_908076

                                                                                                             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:
EMERGENCY REQUEST for 30−Day STA for Fort Meade, Maryland Earth Station E110095
    1. Applicant

              Name:        Intelsat License 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:         Susan H. Crandall                   Phone Number:                         202−944−7848
                 Company:      Intelsat Corporation                Fax Number:                           202−944−7870
                 Street:       3400 International Drive, N.W.      E−Mail:                               susan.crandall@intelsat.com


                 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. CityFort Meade                                                         8. Latitude
                                                                              (dd mm ss.s h)    39   5   27.7    N


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    9. State   MD                                                              10. Longitude
                                                                               (dd mm ss.s h)     76   44   37.6   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 License LLC herein requests a grant of Special Temporary Authority for 30 days,
        from August 1, 2011 through August 31, 2011, to utilize its recently−licensed Fort Meade,
        Maryland Ku−band earth station E110095 with a minor change in the licensed parameters.




    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. Gen. 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 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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Document Created: 2019-04-21 15:25:22
Document Modified: 2019-04-21 15:25:22

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