472215_50_000031986_5-23-2012_8-41-11_PM.pdf

Certification of Officer for Rate-of-Return Carrier Eligibility for CAF/ICC Recovery
I certify that I am an officer of the reporting carrier and that, to the best of my knowledge, the reporting carrier on this form certifies that it
has complied with Eligible Recovery §51.917(d) and Access Recovery Charge §51.917(e) and is eligible to receive the CAF ICC support
requested pursuant to §51.917(f).
Name of Reporting Carrier:
Signature of Authorized Officer or employee:
Printed name of Authorized Officer or employee:
Title or position of Authorized Officer or employee:
Telephone number of Authorized Officer or employee:
Persons willfully making false statements on this form can be punished by fine or forfeiture under the Communications Act of 1934, 47 U.S.C.
§§ 502, 503(b), or fine or imprisonment under Title 18 of the United States Code, 18 U.S.C. § 1001.
Study Area Code of Reporting Carrier Filing Due Date for this form
(mm/dd/yyyy)
Date:
472215 6/18/2012
CAMBRIDGE TEL CO
Kristie Kanady
Billing Manager
208-257-3314
5/23/2012
Kristie Kanady
TO BE COMPLETED BY AN OFFICER OF THE REPORTING CARRIER
Digitally signed by Kristie Kanady DN:cn=Kristie
Kanady,email=[e-mail],O=cambridge tel
co,l=Cambridge ID 83610, Date:5/23/2012