Attachment 20130725145101.pdf

20130725145101.pdf

DECISION submitted by IB/FCC

Grant

2013-07-19

This document pretains to SES-STA-20130711-00584 for Special Temporal Authority on a Satellite Earth Station filing.

IBFS_SESSTA2013071100584_1005226

                                         E020006      SES—STA—20130711—00584   182013001110
                                         Dollar General Corp



                                                                                                                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:
Dollar General Corp VSAT Network TEMP AUTHORITY
 1. Applicant

           Name:        Dollar General Corp                   Phone Number:                   615—855—4342
           DBA Name:                                          Fax Number:
           Street:      100 Mission Ridge                     E—Mail:                         msiebert@dg.com


           City:        Goodlettsville                        State:                          TN
           Country:     USA                                   Zipcode:                        37072       —
           Attention:   Richard M. Siebert




                                                       £8 a,/z?y.s*
                                                                       sess mh2030400594
                                                                         22000 onmbas OFf192073

                                                                       oriefpes, oofrefenrs
                                                                           VE                         w


2. Contact


             Name:         Dollar General Corp                 Phone Number:                          615—855—4342
             Company:                                          Fax Number:

             Street:       100 Mission Ridge                   E—Mail:                                msiebert@dg.com


             City:         Goodlettsville                      State:                                  TN
             Country:      USA                                 Zipcode:                               37072        —
             Attention:                                        Relationship:


(If your application is related to an application filed with the Commission, enter either the file numberor the IB Submission ID of the related
application. Please enter only one.)
3. Reference File Number      or Submission ID 1B2013001108

   4a. Is a fee submitted with this application?
@ IfYes, complete and attach FCC Form 159.         If No, indicate reason for fee exemption (see 47 C.F.R.Section 1.1114).
<y Governmental Entity        g*3 Noncommercial educational licensee
3 Other(please explain):

4b. Fee Classification    —CGV — Fixed Satellite VSAT System
5. Type Request

 g&y Use Prior to Grant                            4 Change Station Location                          g74 Other


6. Requested Use Prior Date
      05/22/2013
7. CityGoodlettsville                                                     8. Latitude
                                                                          (dd mm ss.s h)   36    19     16.0   N


9. State                                                                   10. Longitude
                                                                           (dd mm ss.s h)    86    43     44.0   W
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.)
     Dollar General Corp private VSAT services. Access for all store communications back to
     headquarters.         Previous contact person for DG passed away unexpectedly and while going
     through his files we found that our previous license had expired. Application submitted
     for new Radio Station Authorization under my name.




13. By checking Yes, the undersigned certifies that neither applicant nor any other party to the application is               Yes        {;4 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 &quot;party to the application&quot; for these purposes.


14. Name of Person Signing                                                  15. Title of Person Signing
  Richard M Siebert                                                            Sr. Network Engineer (VSAT)
           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).


FCC NOTICE REQUIRED BY THE PAPERWORK REDUCTION ACT

The public reporting for this collection of information is estimated to average 2 hours per response, including the time for reviewing instructions,
searching existing data sources, gathering and maintaining the required data, and completing and reviewing the collection of information. If you
have any comments on this burden estimate, or how we can improve the collection and reduce the burden it causes you, please write to the
Federal Communications Commission, AMD—PERM, Paperwork Reduction Project (3060—0678), Washington, DC 20554. We will also accept
your comments regarding the Paperwork Reduction Act aspects of this collection via the Internet if you send them to PRA@fcec.gov. PLEASE
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.



Document Created: 2019-05-26 11:46:13
Document Modified: 2019-05-26 11:46:13

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