Application Form

This document pretains to SES-STA-INTR2019-04081 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:

Denali 20020, LLC 509-689-1000
509-689-3798
66 C Teleport Drive [email protected]
Brewster WA
USA 98812 -
Mr Darryl White

Mr Darryl White 509-689-1000
Denali 20020, LLC
66 C Teleport Drive E-Mail: [email protected]
Brewster WA
USA 98812 -
(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
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
12/09/2019
7. CityBrewster 8. Latitude
(dd mm ss.s h)
48 8 49.9 N
9. State WA 10. Longitude
(dd mm ss.s h)
119 41 44.5 W
11. Please supply any need attachments.
Attachment 1: Coordination Notice Attachment 2: Attachment 3:
12. Description. Request for Special Temporary Authority to complete testing with the existing 11.1 meter antenna on Call Sign E190105, License SES-LIC-20190308-00300. Testing is necessary on the Galaxy 15 satellite at 133 degrees West Longitude to support client operations. STA for a duration of 90 days to complete the proposed tests is requested.
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
Darryl White
15. Title of Person Signing
Manager
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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Remember - You are not required to respond to a collection of information sponsored by the Federal government, and the government may not conduct or sponsor this collection, unless it displays a currently valid OMB control number or if we fail to provide you with this notice. This collection has been assigned an OMB control number of 3060-0678.


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