Application Form [pdf]

This document pretains to SES-STA-20160404-00320 for Special Temporal Authority on a Satellite Earth Station filing.

IBFS_SESSTA2016040400320_1132085

                                                                                                         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 for pending Modification to Call Sign E120043 to add a new point of communication
    1. Applicant

              Name:        Denali 20020, LLC         Phone Number:                  509−689−1000
              DBA Name:                              Fax Number:                    509−689−3798
              Street:      66 C Teleport Drive       E−Mail:                        TOCC@usei−teleport.com


              City:        Brewster                  State:                         WA
              Country:     USA                       Zipcode:                       98812       −
              Attention:   Mr Darryl White




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    2. Contact

                 Name:         Mr Darryl White                     Phone Number:                         509−689−1000
                 Company:      Denali 20020, LLC                   Fax Number:
                 Street:       66 C Teleport Drive                 E−Mail:                               TOCC@usei−teleport.com


                 City:         Brewster                            State:                                WA
                 Country:      USA                                 Zipcode:                              98812       −
                 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 IB2016000831
    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
          04/13/2015
    7. CityBrewster                                                           8. Latitude
                                                                              (dd mm ss.s h)    48   8   47.0    N


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    9. State   WA                                                              10. Longitude
                                                                               (dd mm ss.s h)     119   41   29.0    W
    11. Please supply any need attachments.
    Attachment 1: Supporting Statement                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.)
        STA for operation per pending Modification of Call Sign E120043 and the addition of the
        Yamal 300K satellite as a point of Communication.




    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
      Darryl White                                                               Manager
               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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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: 2019-04-25 04:05:54
Document Modified: 2019-04-25 04:05:54

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