Application Form SES-STA-20160310-00198

Application Form

This document pretains to SES-STA-20160310-00198 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:

E960109 STA Request - New POC Operation -Telestar12 V

1. Applicant

Name:	3201 Dickerson Properties LLC	Phone Number:	615-650-5501
DBA Name:		Fax Number:
Street:	3201 Dickerson Pike	E-Mail:	[email protected]

City:	Nashville	State:	TN
Country:	USA	Zipcode:	37207 -
Attention:	Julie C. Stadler

2. Contact

Name:	Christine Reilly	Phone Number:	202-663-8245
Company:	Pillsbury Winthrop Shaw Pittman LLP	Fax Number:	202-663-8007
Street:	1200 Seventeenth Street, NW	E-Mail:	[email protected]

City:	Washington	State:	DC
Country:	USA	Zipcode:	20036 -
Attention:		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 or Submission ID IB2016000653

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
03/15/2016

7. CityNashville

8. Latitude
(dd mm ss.s h) 36 14 6.6 N

9. State TN

10. Longitude
(dd mm ss.s h) 86 45 24.3 W

11. Please supply any need attachments.

Attachment 1: Frequency Coordinati

Attachment 2:

Attachment 3:

12. Description. Applicant seeks special temporary authority ('STA') to commence using the Telstar 12 V as a new point of communication. As the Commission is aware, the applicant concurrently filed a request for modification which seeks permanent authority to add Telstar 12 V, and all associated aspects of that operation, to the E960109 authorization. See IB Submission No. IB2016000653. current E960109 facilities to ADD operations in the extended Ku band using Telstar 12 Vantage. No other changes are proposed and the previously licensed operations shall remain unchanged as a result of the instant proposal.

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
Julie C. Stadler

15. Title of Person Signing
President

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 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.