Application Form

This document pretains to SES-STA-20181130-03355 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 US LLC susan.crandall@intelsat.com
7900 Tysons One Place
McLean VA
USA 22102 -5972
Susan H. Crandall

Cynthia J. Grady 703-559-6949
Intelsat US LLC 703-559-8539
7900 Tysons One Place E-Mail: cynthia.grady@intelsat.com
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 SESMOD2018091202820 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 CGV - Fixed Satellite VSAT System
5. Type Request
Use Prior to Grant Change Station Location Other
6. Requested Use Prior Date
7. CityHagerstown 8. Latitude
(dd mm ss.s h) 39 42 0.0 N
9. State MD 10. Longitude
(dd mm ss.s h) 77 44 0.0 W
11. Please supply any need attachments.
Attachment 1: STA Request Attachment 2: Exhibit A Attachment 3:
12. Description. Intelsat License LLC herein requests grant of Special Temporary Authority for 30 days, commencing December 11, 2018, to temporarily operate a new Ku-band remote VSAT terminal with its Mountainside, Maryland VSAT hub, Call Sign E110013, in order to communicate with Galaxy 3C at 95.0 W.L. for a customer demonstration.
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
Senior Counsel, Intelsat US LLC
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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