Application Form

This document pretains to SES-STA-20160622-00569 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:

NexTech Solutions LLC 904-458-7658
904-385-5715
4265 Eagle Landing Pkwy [email protected]
Orange Park FL
USA 32065 -
Mr James B Pruitt

J. Brian Pruitt 813-602-4090
NexTech Solutions LLC 904-385-5715
4265 Eagle Landing Pkwy E-Mail: [email protected]
Orange Park FL
USA 32065 -
Same
(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 IB2016001140
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 CGB - Mobile Satellite Earth Stations
5. Type Request
Use Prior to Grant Change Station Location Other
6. Requested Use Prior Date
08/09/2016
7. CityNorfolk 8. Latitude
(dd mm ss.s h) 36 54 50.71 N
9. State VA 10. Longitude
(dd mm ss.s h) 76 11 7.9 W
11. Please supply any need attachments.
Attachment 1: Form 312 Attachment 2: Radiation Pattern Attachment 3: System Description
12. Description. NexTech Solutions, LLC (NTS) FEIN 46-3073199 is seeking to demonstrate a GetSAT Micro, panel based phased array antenna operating in the Ka-band to the Department of DefenseUS Special Operations Command has invited NexTech Solutions to participate in a military exercise-SOCOM Technical Experiment 16-4
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
James Brian Pruitt 		15. Title of Person Signing
Sr. Sales Engineer
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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