Application Form

This document pretains to SES-STA-20191206-01663 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:

Alaska Communications Internet, LLC 907-297-3000
907-297-3153
600 Telephone Avenue [email protected]
MS #60
Anchorage AK
USA 90503 -
Ms. Lisa Phillips

Richard Cameron 2022304962
LMI Advisors
2550 M Street NW E-Mail: [email protected]
Suite 343
Washington DC
USA 20037 -
Other
(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
SESSTA2019080901040 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
12/10/2019
7. CityVarious 8. Latitude
(dd mm ss.s h)
0 0 0.0
9. State AK 10. Longitude
(dd mm ss.s h)
0 0 0.0
11. Please supply any need attachments.
Attachment 1: Narrative Attachment 2: Technical Appendix Attachment 3: Draft 312 Schedule B
12. Description. 60-Day STA Extension for OTZ Sites.
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
Rick Benken
15. Title of Person Signing
VP
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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