Application Form SES-STA-20110427-00513

Application Form

This document pretains to SES-STA-20110427-00513 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:

Special Temporary Authority for a 3.8 meter antenna for use prior to grant.

1. Applicant

Name:	Americom Government Services, Inc.	Phone Number:	703-610-1002
DBA Name:		Fax Number:	703-610-1030
Street:	2010 Corporate Ridge, Suite 600	E-Mail:	rick.minter@americom-gs.com

City:	McLean	State:	VA
Country:	USA	Zipcode:	22102 -
Attention:	Rick Minter

2. Contact

Name:	Maurice Najarian	Phone Number:	703 610-0985
Company:	Americom Government Services, Inc	Fax Number:
Street:	2010 Corporate Ridge, Suite 60	E-Mail:	Maurice.Najarian@ses-usg.com

City:	McLean	State:	VA
Country:	USA	Zipcode:	22102 -
Attention:		Relationship:

(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 IB2011001213

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
05/06/2011

7. CityAtlanta

8. Latitude
(dd mm ss.s h) 33 22 48.0 N

9. State GA

10. Longitude
(dd mm ss.s h) 84 17 24.0 W

11. Please supply any need attachments.

Attachment 1: STA Narrative

Attachment 2:

Attachment 3:

12. Description. STA for use of proposed 3.8 meter C-band T/R earth station prior to grant of pending FCC Application under submission ID

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
Maurice Najarian

15. Title of Person Signing
Systems 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.