Application Form

This document pretains to SES-STA-20210322-00545 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, as debtor-in-possession 703-559-7799
703-559-8539
7900 Tysons One Place ray.rutngamlug@intelsat.com
McLean VA
USA 22101 -5972
W. Ray Rutngamlug

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 SESLIC2020122201428 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. CityBrewster 8. Latitude
(dd mm ss.s h) 48 8 45.6 N
9. State WA 10. Longitude
(dd mm ss.s h) 119 41 50.3 W
11. Please supply any need attachments.
Attachment 1: STA Request Attachment 2: Attachment 3:
12. Description. Intelsat herein requests an additional 60 days of Special Temporary Authority previously granted to Intelsat to use its Brewster, Washington C-band earth station for antenna verification testing.
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
Assistant General 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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