Application Form

This document pretains to SES-STA-INTR2004-00085 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:

L3 Communications GNS-TSS 321-751-4608 x210
321-751-4648
720 North Drive [email protected]
Melbourne FL
USA 32934 -
Mr Michael J Beattie

Jeff Vanwie 321-751-4608
L3 Communications 321-751-4648
720 North Drive E-Mail: [email protected]
Melbourne FL
USA 32934 -
Manager of Engineering Engineer
3. Reference File Number SESLIC2003122401862
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
01/21/2004
7. CityMelbourne 8. Latitude
(dd mm ss.s h)
28 6 54.0 N
9. State FL 10. Longitude
(dd mm ss.s h)
80 41 26.0 W
11. Please supply any need attachments.
Attachment 1: Attachment 2: Attachment 3:
12. Description. This is a temporary until we receive our permanent license to transmit file # SES-LIC-20031224-01862. Would like to start some equipment testing on 21 Jan through 21 March 2004. We hope to have the license prior to the termination of the 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
Mike Beattie
15. Title of Person Signing
Dir of Proj Engineering & Tech Mktg
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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