Attachment Form 159

This document pretains to SAT-MOD-20040405-00077 for Modification on a Satellite Space Stations filing.

IBFS_SATMOD2004040500077_371070

READ INSTRUCTIONS CAREFULLY Approved by OMB BEFORE PROCEEDING FEDERAL COMMUNICATIONS COMMISSION 30604589 REMITTANCE ADVICE Page 1- of-- 1 I (4) STREET ADDRESS LINE NO I 1801 K Street. N.W. (5) STREET ADDRESS LINENO 2 I (1 4) STREET ADDRESS LINE NO 1 I 1801 K Street, N.W. ( I 5 ) STREET ADDRESS LINE NO 2 ( 16) CITY (17) STATE (18) ZIP CODE Washinaton DC 20006 - 202-292-4300 FCC _. REGISTRATION _ _ .. ~. NUMBERlFRNl REOUIRED I ~ (21) APPLICAU I (FRhI (22)FCCUSB ONLY 0005848577 c o b i P L E i E SEC r i m c FOR EACH S E R V I C E . IC MORF BOXFS A R E Y E E D E D . I'SL C O ~ T I \ L A T I O \SHEET I I SECTION D- CERTIFICATION CERTIFICATION STATEMENT I. , certify under penalty ofperjury that the foregoing and supporting information is true and correct to the best o f m y knowledge, information and belief SIGNATURE DATE - SECTION E CREDIT CARD PAYMENT INFORMATION MASTERCARD- VISA- AMEX- DISCOVER- ACCOUNT NUMBER EXPIRATION DATE 1 hereby authorize the FCC to charge my credit card for the service(s)/authorizati~herein described. SIGNATURE DATE SEE PUBLIC BURDEN ON REVERSE FCC FORM 159 FEBRUARY ZOO3(REVISED)


Document Created: 2004-04-29 14:26:26
Document Modified: 2004-04-29 14:26:26
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