20190614Custer Telephone CAF ICC.pdf

I certify that I am an ofner ot the reportlng c..rier; my Gsponslblllties lnclude ensurlng thc accu6cy oflhe actual data rcported;
and, to the bc8l ol my knowledgG, thg lntormatlon reported on lhls form ls acquEte.
Certllicallon of Ofticar as to the Accuracy of the CAF ICC Oata Rsportsd
Name of Reporting Carier:CUSTER TEL. COOPERATIVE INC.
Doilally signd by Dennis Thorn@k ON:cn=Dennis
Thornock,email=dennis@cuslenel,nel.O:cusler lel.
cooperative inc..l=Challis lD 83226, Date:5/20/2019
Dennis Thornock
Signature of Authorized Ofiicer:oate: 512812019
Printed name of Authorized Officer:Oennis Thornock
Title or position of Authorized Officer:Chief Executive Officer
TelephonenumberofAuthorizedOfficer: 208-879-2281
Study Area Code of Reporting Canier 472218 Filing Due Date for this
form (mm/dd/yyyy)6117t2019
Porlgnt willfully maklng f.lto staigmqnts on this lo.m can bq punlrhgd by fin. o. torfoiture undgr the Communlcation. Act ot 1934,
,t7 U.S.C. !S 502, 503(b), or flno or lmprlronnont undor Title lE of tho Unltcd Stat* Code, l0 U.S.C. S 1001,
-T-TO BE COMPLETED BY THE REPORTING CARRIER,o
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TO BE COMPLETED BY THE REPORTING CARRIER. IF AN AGENT IS FILING DATA ON THE CARRIER'S BEHALF:
Certlficatlon ot Officer to Authorlze an Agent to File Data Reported on Behalf of Reporting Carrier
I certity that (Namo otAgent)National Exchange Carriers Association. Fstrhortzed to Bubmtr theInlormatlon rcponcd 06
behalt oflhe reporting carrier. I alBo certify that l am an ofricer of the rcporting carier; my responsibilities include ensuring the
eccuracy otthe data provlded lo the Autho,lzed Agent; and, to the best of my knwoledgo, the actual data provlded to lho Autho.ized
Name of Authorized Agent National Exchange Carriers Association, lnc.
Name of Reporting Carrier:CUSTER TEL. COOPERATIVE INC.
Dennis Thornock
Digilally signed by Dennis Thomock DN:cn.Dennis
Thornoci,eroil=[e-mail],O=cusler tel.
c@peralive inc.,l:Challis lD 83226, Date:5/28/2019
Signature of Authorized Ofricer:Date: 512812019
Printed name of Authorized Officer:Dennis Thornock
Title or position of Authorized Ofiicer:Chief Executive Officer
Telephone number of authorized officer:208-879-2281
Study Area Code of Reporting Carrier 472218 Filing Due Date for this
form (mm/dd/yyyy)6t1712019
PeEons wllltully making false statemqnts on this to.m can bo punishgd by fln. o. fortailure under tho Communlcatlons Act of '1934,
47 U.S.C. SS 502, 503(b), or fine or lmprlsonmenl under lltle lE of the Unllod Stales Code, 1E U.S.C. S 1001.
TO BE COMPLETED BY AN OFFICER OF THE REPORTING CARRIER
certlficatlon of Officer for Rated-Rolurn Carrier Ellglbillty for CAF/ICC Recovery
I certify th.t I am an oftlBt ot the Eportlng ca,rle. and that, to th6 best ot my knowledge, the reportlng canicr on this fo.m
ccrllile3 lhat h h.! compllcd with Ellgible Recovery S51.917(d) and Accese Recovery Charge S51.917(e) and l. eligible to .e@lve the
CAF ICC auppoit Equo3ted puEurnt to S5'1.917(0,
Name of Reporting Carrier:CUSTER TEL, COOPERATIVE INC
Dennis Thornock Digilally signed by Dennis Thomock DN:cn.Dennis
Thornoci,eruil:[e-mail],O=cusler tel.
coopemtiw inc.,t=Chatlis tO 83226, oale:5/2812019
Signature oI Authorized Officer or employee:Date: 512812019
Printed name of Authorized Officer or employee:Dennis Thornock
Title or position of Authorized Officer or employee:Chief Executive Officer
Telephone number of Authorized Officer or employee:208-879-2281
Study Area Code of Reporting Carrier Filing Due Date for this
fom (mm/dd/yyyy)6117t2019
Po6ons wlllfully making talso stalemgnts on thls form can bo punishgd by tinc or forteituro unde, tho Communicatlons Act of 1934,
47 U.S.C. SS 502, 503(b), o. flne or lmprlsonment under Tllle lE ot the Unlted States Code, 1E U.S.C. S 1001,
4?22$
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TO BE COMPLETED BY AN OFFICER OF THE REPORTING CARRIER
Csrtlflcatlon of Offlcer for Rate{f-Return Carrler Not Seeklng Oupllcatlve Recovery
I cortily that I am an otflcer of the reportlng carrle. and that, to thc bcat of my knowledgo, the reporling car,ler Is not sGeklng
duplicatlve .ecovery ln lhe slate rurbdlction for any Eliglble Rccovery .ublect to lhe reovery mechanlsm as per S51.917(dxvii).
Name of Reporting Carrier:CUSTER TEL. COOPERATIVE INC
Dennis Thornock
Oigitally signed by Oennis Thomock ONrcn--Dennis
l'hornock,email.dennis@custe(el.nol,O=custer lel.
coopeGriw inc.,l=chailis lD 03226. Date:5/2&2019
Signature of Authorized Officer or employee:Dater 512812019
Printed name of Authorized Oflicer or employee:Dennis Thornock
Title or position of Authorized Officer or employee:Chief Executive Officer
Tel€phone number of Authorized Officer or employee:204-875-2281
Study Area Code of Reporting Carrier Filing Due Date for this
form (mm/dd/yyyy)6t17t?019
Psrgons wlllfully maklng ,alss statamenb on this lorm can be punlshed by fino or forfgiturg undir the Communicatiohs Acl o, 1934,
47 U.S.C, SS 502, 503(b), or flne or lmp.isonmsnt undor Titlo l0 of lhs Unlted States Cqde, 18 U.S.C. S 1@1.
472218 | I