Application Form

This document pretains to SES-STA-20110818-00967 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:

Convergent Media Systems Corporation 770-369-9363
770-369-9100
One Convergent Center [email protected]
190 Bluegrass Valley Parkway
Alpharetta GA
USA 30005 -
Glen Haynes

Timothy J. Cooney 202-783-4141
Wilkinson Barker Knauer, LLP 202-783-5851
2300 N Street, NW E-Mail: [email protected]
Washington DC
USA 20037 -1128
Timothy J. Cooney 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 IB2011004017
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
08/22/2011
7. CityAlpharetta 8. Latitude
(dd mm ss.s h) 34 6 42.0 N
9. State GA 10. Longitude
(dd mm ss.s h) 84 13 1.0 W
11. Please supply any need attachments.
Attachment 1: Attachment 2: Attachment 3:
12. Description. Applicant seeks special temporary authority to operate in accordance with expired earth station license E000689 as the FCC processes a simultaneously filed Form 312 for a new Ku Band license with the same technical parameters.
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
Trevor Davies 		15. Title of Person Signing
Vice President of Engineering
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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