Application Form SES-STA-INTR2021-01604

Application Form

This document pretains to SES-STA-INTR2021-01604 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:

E990216 Hawley STA

1. Applicant

Name:	SES Americom, Inc.	Phone Number:	202-478-7143
DBA Name:		Fax Number:	202-478-7111
Street:	1129 20th Street NW	E-Mail:	petra.vorwig@ses.com
	Suite 1000
City:	Washington	State:	DC
Country:	USA	Zipcode:	20036 -
Attention:	Ms Petra A Vorwig

2. Contact

Name:	Jack Narciso	Phone Number:	609-480-5375
Company:	SES Americom, INC.	Fax Number:
Street:	4 Research Way	E-Mail:	jack.narciso@ses.com

City:	Princeton	State:	NJ
Country:	USA	Zipcode:	08540 -
Attention:		Relationship:	Engineer

(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 SESMFS2021041900701 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
05/03/2021

7. CityHawley

8. Latitude
(dd mm ss.s h) 41 27 50.4 N

9. State PA

10. Longitude
(dd mm ss.s h) 75 7 47.9 W

11. Please supply any need attachments.

Attachment 1:

Attachment 2:

Attachment 3:

12. Description. SES Americom respectfully requests earth station special temporary authority for a period of 60 days beginning no later than May 3rd, 2021 to permit SES to use its E990216 earth station to communicate with satellites on the FCC's permitted list. SES seeks STA pending Commission action on a modification application requesting regular authority for this operation and incorporates by referencing the supporting information provided with the modification application. See file no. SES-MFS-20210419-00701.

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

14. Name of Person Signing
Jack Narciso

15. Title of Person Signing
Engineer

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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THE FOREGOING NOTICE IS REQUIRED BY THE PAPERWORK REDUCTION ACT OF 1995, PUBLIC LAW 104-13, OCTOBER 1, 1995, 44 U.S.C. SECTION 3507.