Application Form [pdf]

This document pretains to SES-STA-20130510-00377 for Special Temporal Authority on a Satellite Earth Station filing.

IBFS_SESSTA2013051000377_996691

                                                                                                              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:
STA 05/10/2013
    1. Applicant

              Name:        Sure Shot Transmissions, Inc.   Phone Number:            330−542−0900
              DBA Name:                                    Fax Number:              330−542−1020
              Street:      P.O. Box 489                    E−Mail:                  cblasko@sureshotsat.com
                           10314 Main Street
              City:        New Middletown                  State:                   OH
              Country:     USA                             Zipcode:                 44442       −0489
              Attention:   Ms Carolyn Blasko




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    2. Contact

                 Name:         Sure Shot Transmissions, Inc.       Phone Number:                        330−542−0900
                 Company:                                          Fax Number:                          330−542−1020
                 Street:       P.O. Box 489                        E−Mail:                              cblasko@sureshotsat.com
                               10314 Main Street
                 City:         New Middletown                      State:                                OH
                 Country:      USA                                 Zipcode:                             44442         −0489
                 Attention:                                        Relationship:


    (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 IB2013001000
    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
          05/13/2013
    7. CityVarious                                                            8. Latitude
                                                                              (dd mm ss.s h)    0   0   0.0


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    9. State                                                                   10. Longitude
                                                                               (dd mm ss.s h)     0   0   0.0
    11. Please supply any need attachments.
    Attachment 1:                                     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.)
        Request to grant Special Temporary Authorization of call sign E940167 to continue to
        conduct business without interruption while IB2013001000 is under review for grant




    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
      Carolyn Blasko                                                             Financials
               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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Remember − You are not required to respond to a collection of information sponsored by the Federal government, and the government may not
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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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Document Created: 2019-04-14 17:19:51
Document Modified: 2019-04-14 17:19:51

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