Application Form SES-STA-20160414-00349

Application Form

This document pretains to SES-STA-20160414-00349 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:

STA for Satellite Earth Station Assignment

1. Applicant

Name:	American Samoa License, Inc.	Phone Number:	684-699-2759 x1016
DBA Name:		Fax Number:	684-699-6593
Street:	478 Lafou Shopping Center	E-Mail:	[email protected]
	P.O. Box 478
City:	Pago Pago	State:	AS
Country:	USA	Zipcode:	97699 -0478
Attention:	Mr Adolfo Montenegro

2. Contact

Name:	Kent D. Bressie	Phone Number:	2027301337
Company:	Harris, Wiltshire & Grannis LLP	Fax Number:
Street:	1919 M Street, N.W., Suite 800	E-Mail:	[email protected]

City:	Washington	State:	DC
Country:	USA	Zipcode:	20036 -3537
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 SESASGINTR201600908 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
03/15/2016

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 2:

Attachment 3:

12. Description. American Samoa License, Inc. requests a special temporary authorization pending approval of the Consent to Assignment of License to AST Telecom, LLC, d/b/a Bluesky. The transaction took place prior to approval of the pro forma assignment.

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
Adolfo Montenegro

15. Title of Person Signing
President and CEO

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.