Application Form

This document pretains to SES-STA-INTR2003-00852 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 LLC 202-944-7891
202-944-7860
3400 International Drive, N.W. [email protected]
Washington DC
USA 20008 -3006
Robert A Mansbach

Robert A. Mansbach 202-944-7891
Intesat LLC 202-944-7860
3400 International Drive, N.W. E-Mail: [email protected]
Washington DC
USA 20008 -3006
Assistant General Counsel Legal Counsel
3. Reference File Number
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
04/20/2003
7. CityClarksburg 8. Latitude
(dd mm ss.s h)
39 13 5.2 N
9. State MD 10. Longitude
(dd mm ss.s h)
77 16 13.9 W
11. Please supply any need attachments.
Attachment 1: 1 Attachment 2: Attachment 3:
12. Description. Intelsat LLC requests an extension of STA from 04/20/03 through 10/20/03 to provide service from its Clarksburg, MD KA264 earth station using certain additional emission designators at EIRP densities equal to, or less than, those already licensed.
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
Patrick J. Cerra
15. Title of Person Signing
Vice President
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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