Application Form

This document pretains to SES-STA-20160707-00633 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:

Intelsat License LLC 703-559-7848
703-559-8539
c/o Intelsat Corporation [email protected]
7900 Tysons One Place
McLean VA
USA 22102 -5972
Susan H. Crandall

Cynthia J. Grady 703-559-6949
Intelsat Corporation 703-559-8539
7900 Tysons One Place E-Mail: [email protected]
McLean VA
USA 22102 -5972
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
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
7. CityFillmore 8. Latitude
(dd mm ss.s h)
34 24 22.0 N
9. State CA 10. Longitude
(dd mm ss.s h)
118 53 34.0 W
11. Please supply any need attachments.
Attachment 1: STA Request Attachment 2: Attachment 3:
12. Description. Intelsat License LLC herein requests a grant of Special Temporary Authority for 30 days, commencing immediately upon grant, to use its Fillmore, California C-band earth station, call sign E4132, to perform de-orbit maneuvers for the non-geostationary Sirius FM-2 satellite (collectively with Sirius FM-1 and Sirius FM-3, call sign S2105). Sirius FM-2 is currently being de-orbited and the de-orbit is expected to last approximately 30 days.
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
Cynthia J. Grady
15. Title of Person Signing
Regulatory Counsel, Intelsat Corporation
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.


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