Application Form SES-STA-20170901-00978

Application Form

This document pretains to SES-STA-20170901-00978 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:

Request for 30-Day STA to Test 9m Ku-band Antenna in Woodbine, MD (K-13)

1. Applicant

Name:	SES Americom, Inc.	Phone Number:	202-478-7143
DBA Name:		Fax Number:	202-478-7111
Street:	1129 20th Street NW	E-Mail:	[email protected]
	Suite 1000
City:	Washington	State:	DC
Country:	USA	Zipcode:	20036 -
Attention:	Ms Petra A Vorwig

2. Contact

Name:	George Varkey	Phone Number:	609-987-4327
Company:	SES Americom, Inc.	Fax Number:
Street:	4 Research Way	E-Mail:	[email protected]

City:	Princeton	State:	NJ
Country:	USA	Zipcode:	08540 -
Attention:		Relationship:	Engineer

(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
09/12/2017

7. CityMount Airy

8. Latitude
(dd mm ss.s h) 39 22 36.5 N

9. State MD

10. Longitude
(dd mm ss.s h) 77 4 49.4 W

11. Please supply any need attachments.

Attachment 1: STA Narrative

Attachment 2:

Attachment 3:

12. Description. SES Americom, Inc. respectfully requests special temporary authority (STA) for 30 days beginning September 12, 2017 to test a 9m antenna located at its Woodbine, MD facility in the conventional Ku−band with AMC−15 (Call Sign S2180). See attachment.

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
Petra A. Vorwig

15. Title of Person Signing
Senior Legal & Regulatory Counsel

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.