Application Form SES-STA-20140911-00710

Application Form

This document pretains to SES-STA-20140911-00710 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:

Flint & Toledo STA Request for Approval to Consummate

1. Applicant

Name:	Gray Television Licensee, LLC	Phone Number:	404-504-9828
DBA Name:		Fax Number:
Street:	4370 Peachtree Road, NE	E-Mail:	[email protected]

City:	Atlanta	State:	GA
Country:	USA	Zipcode:	30319 -
Attention:	Kevin Latek

2. Contact

Name:	Robert J. Folliard III	Phone Number:	202-7762357
Company:	Cooley LLP	Fax Number:
Street:	1299 Pennsylvania Avenue, NW	E-Mail:	[email protected]
	Suite 700
City:	Washington	State:	DC
Country:	USA	Zipcode:	20004 -
Attention:	Robert Folliard	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 SESASG2014090300692 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
09/15/2014

7. City

8. Latitude
(dd mm ss.s h) 0 0 0.0

9. State

10. Longitude
(dd mm ss.s h) 0 0 0.0

11. Please supply any need attachments.

Attachment 1: Attachment 1

Attachment 2:

Attachment 3:

12. Description. Applicant requests Special Temporary Authority to consummate the transactions noted in Exhibit 1 prior to FCC approval.

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

14. Name of Person Signing
Kevin P. Latek

15. Title of Person Signing
Secretary

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 d ata, 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 [email protected]. 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.