Attachment FCC 159 Completed

This document pretains to SES-STA-INTR2014-02281 for Special Temporal Authority on a Satellite Earth Station filing.

IBFS_SESSTAINTR201402281_1069385

READ INSTRUCTIONS CAREFULLY Approved by OMB BEFORE PROCEEDING FEDERAL COMMUNICATIONS COMMISSION 30600509 REMITTANCE ADVICE PageNo_1 of2 rorm 1s9 (DLOcKBOX# SECTION A — PAYER INFORMATION E)FAYER NAME (if paying by credit card enter name exactly as it appears on the card) (3) TOTAL AMOUNT PAID (U.5. Dollars and cents) JO MARK—BROWN TVNZ LTD $180.00 (4)STREET A DDRESS LINE NO.l 100 Victoria Street West, PO Box 3819 (5) STREET ADDRESS LINE NO 2 (6)CHYy M STATE (8) ZiP CODE Auckland (©) DAYTIME TELEPHONE NUMBER (include area code) (10) COUNTRY CODE (if not in U.S.A.) 09 916 7279 +64 ECC REGISTRATION NUMBER (FRN) REQUIRED (11) PAYER (PRN) 12) EGG USEON 0024096158 IF MORE THAN ONE APPLICANT, USE CONTINUATION SHEETS (FORM 159—C) COMPLETE SECTION BELOW FOR EACH SERVICE, IF MORE EOXES ARE NEEDED, USE CONXTINDATiON SHEET (13) APPLICANT NAME Television New Zealand Ltd (14) STREET ADDRESS LINE NO.| 100 Victoria Street West, PO Box 3819 (15) STREET ADDRESS LINE NO. 2 0) CHy (17)STATE (18) ZIP CODE Auckland, New Zealand 1041 (19) DA VTIME TELEPHONE NUMBER Gnclude area code) (20) COUNTRY CODE (if not in U.S.A.) 09 916 7175 +64 FCC REGISTRATION NUMBER (FRN) REQUIRED (21) APPLICANT(FRN) 2 CUSEON! 0024096158 COMPLETE SECTION C FOR EACHSERVICE, IF MORE BOXES ARE NEEDED, USE CONTINUATION SHEET (234) CALL SIGNIOTHER ID (24A) PAYMENT TYPE CODE (25A) QUANTITY TVNZ SNG 04 CGB 1 (26A) FEE DUE FOR (PTC) (27A) TOTAL FEE R SEONE $180.00 180.00 (284) FCC COpET (@>A) FCC CopE2 (238) CALL SIGN/OTHER ID (24B) PA YMENT TYPE CODE (@5B) QUANTITY (26B) FEE DUE FOR (PTC) (@7B) TOTAL FEE (@28B)FCC CODEI (298) FCC CopE2 SECTIOND — CERTIFICATION CERT]FICA;};}N STATEME)§T — 1 2207 Hes) CYOE . certify under penelty ofperjury thatthe foregoing and supporting information is true and correct to the best of my knowledge, information and beliet, stonature L7 pate /?N////é' SECTION E. CREDIT CARD PAVMENT INFORMATION MASTERCARD____= — v AmEx piscover_____ ACCOUNT NUMBER 79 1406 e04, 339} EXPIRATION DATE O 94 7 7 Ihereby nuthoriga GShbization herein described. [ C( / / Date ~ +/ L/L SEE PUBLIC BURDEN ON REVERSE ECC FORM 159 FEBRUARY 2003

Approved by OMB 20600589 FEDERAL COMMUNICATIONS COMMISSION REMITTANCE ADVICE (CONTINATION SHEET) FORM 159—C PageNo2 or2 USE THIS SECTION ONLY FOR EACH ADDITIONAL APPLICANT SECTION BB — ADDITIONAL APPLICANT INEORMATION (13) APPLICANT NAME (14) STREET ADDRESS LINE NO.1 ' (13) STREET ADDRESS LINE NO. 2 I (6)CHYy (17)STATE (18) ZiPCODE (19) DA YTIME TELEPHONE NUMBER (include area code) (20) COUNTRY CODE (if not in U.S.A.) FCC REGISTRATION NUMBER (FRN) REQUIRED (21) APPLICANT(FRN) 22)reCUsEON COMPLETE SECTION C FOR EACH SERVICE, IF MORE BOXES ARE NEEDED, USE CONTINUATION SHEET (23A) CALL SIGNOTHER iD | 4) PAYMENT TyPE cobe @sa) quantity (264) FEE DUE FOR(PTC) (27a) Torat Fee asavFee copet (@oa) Feccope2 (236) CALL SIGNIOTHERtD (248) PAYMENT TyPE Cope (258) QuanmiTy (262) Fee puE FOR(PTC) (@78) Toracree (@smrcccope1 (@omrcc cope2 (@3C) CALL SIGNIOTHER in BC PavMENT yPe cobE 5o) quantity (250) Fee puz For (PTC) (27c)TorALFEE cusEON (@sc)rcecopE1 @c)rce cope2 (230) CALL SIGNOTHER Ip | @4D) rAyMeNT TypE cope (25D) quaNTITY (260) FEE DUE FOR (PTC) (270)ToTAL FEE @spmrce copet (25D) Fee cope2 236) CALL Stanothek ip | C4BpayMENT TvPE coDF (2SB) quantiTy (258) Fee DuE FOR (PTC) 27etoraLree (282) Fec.copeI (292) reccope2 (232) CALL SIGN/OTHER ID (24F) PAYMENT TYPE CODE @sP quantity (268) FeE puE FoR (PrC) (279) TOTAL FEE USEONE (@smrcccopEs @omEcecope2 SEE PUBLIC BURDEN ON REVERSE FCC EORM 159—C FEBRUARY 2003


Document Created: 2014-11-19 10:11:48
Document Modified: 2014-11-19 10:11:48
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