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:

3201 Dickerson Properties LLC 615-650-5501
3201 Dickerson Pike [email protected]
Nashville TN
USA 37207 -
Julie C. Stadler

Christine Reilly 202-663-8245
Pillsbury Winthrop Shaw Pittman LLP 202-663-8007
1200 Seventeenth Street, NW E-Mail: [email protected]
Washington DC
USA 20036 -
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 No
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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