Application Form

This document pretains to SES-STA-20121109-01008 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:

Americom Government Services, Inc. 703-610-1002
703-610-1030
2010 Corporate Ridge, Suite 550 [email protected]
McLean VA
USA 22102 -
Rick Minter

Karis Hastings 202-599-0975
SatCom Law LLC
1317 F Street, NW E-Mail: [email protected]
Suite 400
Washington DC
USA 20004 -
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
11/14/2012
7. CityLaurel 8. Latitude
(dd mm ss.s h)
39 2 43.0 N
9. State MD 10. Longitude
(dd mm ss.s h)
76 51 46.0 W
11. Please supply any need attachments.
Attachment 1: STA Request Attachment 2: Attachment 3:
12. Description. Americom Government Services, Inc. (SES-GS) respectfully requests STA for a period of 60 days to operate a C-band antenna at a site in Laurel, MD, pending action on an application for permanent licensing of the antenna, File No. SES-LIC-20121108-00997.
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
Rick Minter
15. Title of Person Signing
VP and COO
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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