20190614Farmers Mutual Telephone CAF ICC.pdf

TO BE COMPLETED BY THE REPORTING CARRIER,Q**,-T- rt-o 1
Certlflcatlon of Offlcer as to the Accur.cy of ths CAF ICG Data Reported
I certlty that I am an ofrler ot the eportlng ca.rle.; my caponsibllltlGs lnclude ensurlng tho .ccumcy ot lhe aclual data Gported;
and, lo the bert o, my knowledge, the lnlormatlon rcported on thl. ,om i. accuEh,
Name of Reporting Carrier:FARMERS MUTUAL TEL CO LTD. . ID
Daniel Greig
Oiqitsllysignod by Daniel Greig ON:co=Oa.iel
Orelg,[e-mail],O=f armeE mulual tel @ ltd.
- id.l=Ftuiuand lD Bs19. Dete:5t17no1g
Signature of Authorized Officer:
Date: 51171?019
Printed name oI Authorized Officer:Daniel Greig
Tille or position of Authorized Offlcer:General Manager
TelephonenumberofAuthorizedOfficer: 208-452-3100
Study Area Code of Reporting Carier 472221 Filing Due Date for this
form (mm/dd/yyyy)6t17t2019
PeGons wlllfully mallng t lso 3tatomnl! on thlg lotm can bg punlshod by flng or forlolture undor tho Communlcstion! Act ot 1934,
47 U.S.C. SS 502, 503(b), ar tln! or lmprlsonmcnt undor Tltle l E of the Unltrd Stat r Codo, 18 U.S.C. ! 1 001.
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TO BE COMPLETED BY THE REPORTING CARRIER, IF AN AGENT IS FILING DATA ON THE CARRIER'S BEHALF:
Certification of Officer to Authorize an Agent to File Data Rcported on Behalf ot Reporting Carrier
I ccdlry th.l (Name otAgent)National Exchange Carriers Association,lnc.is authorlzed to submit the information repoiled on
behal, o, lhe .eponlng carrier. I also cerlify lhat I am an ofticer of the rcporting ca.rier; my r*ponsibllilies lnclude ensu.ing lhe
accuracy oflhe data provlded to lhe Authorl.ed Agent; and, to the best of my knwolBdge, ths actual data provided to tho Authorized
Name ol Authorized Agent : National Exchange Carriers Association, lnc.
Name of Reporting Carrier:FARMERS MUTUAL TEL CO LTD. - ID
Daniel Greig
Oigilelly signed by Deniel Greig ON:cn=Daniel
Greig,omail=dan@lmlc com,O=lamec mulual tol co lld.
id,l:Frui{and t0 83619. D6re:5/1 7/2019
Signature of Authorized Officer:Date: 511712019
Printed name of Authorized Officer:Daniel Greig
Title or position of Authorized Officer:General Manager
Telephone number of authorized officer:208-452-3100
Study Area Code oI Reporting Carrier 472221 L_l Filing Due Date for this
form (mm/dd/yyyy)6t17t2019
P.Eons wlllfully making talso 3tatements on this torm can be punished by flns or forfrrituro undor tho Communications Acl of 1934,
47 U.S.C. SS 502, 503(b), or tlne or imprlsonment undsr ?itle lE ot the United Statss Code, 'tA U.S.C. S 100i.
TO BE COMPLETED BY AN OFFICER OF THE REPORTING CARRIER
Certlllcatlon of Offlcar for Rats.f-Return Carrier Eligiblllty for CAF/ICC RGcovery
I certify that I am an offle. ot the Eponlng carrie. and that, to thc bcst of my knowledge, the .eportlng carrier on lhis form
ccrlitic. thal lt has complled wlth Ellglble Recovery S51.917(d) and Acce3. Recovery Charge S51.9'17(e) and ls ellglble to recelve the
CAF ICC suppon equ.lt d puEuent to S5'1.917(f).
Name of Reporting Carrier:FARMERS MUTUAL TEL CO LTD. - ID
Oaniel Greig
Digilally signod by Daniel Greig ON:cn=Daniel
G.eig,email:[e-mail],O=l.merc mutual telco ltd.
id,l--Fruitlend lD 8361S, Oab:5117 i2019
Signature of Authorized Officer or employee:oate: 511712019
Printed name of Authorized Oflicer or employee:Daniel Greig
Title or position of Authorized Officer or employee:General Manager
Telephone number of Authorized Officer or employee:208-452-3100
Study Area Code of Repoilng Carier 472221 Filing Due Date for this
form (mm/dd/yyyy)6t17t2019
PcEons wllltully making falso statemont3 on this lorm can be punl.hed by tine or forteiture undo, lho Communications Act ot '1934,
47 U.S.C, SS 502, 503(b), or flne or lmprlsonment under Tltle 1E ol the Unltod Steles Code, 18 U.S,C. S 1001.
I
TO BE COIVPLETED BY AN OFFICER OF THE REPORTING CARRIER
Certlflcation of Ofticer for Rate{f-Return Carrier Not Seeking Dupllcatlve Recovery
I cartlfy that I am an offlce. ol the eportlng ca.rier and that, to the best of my knowledge, the repo.ting carrlar Ir not seeklng
dupllcatlre recovcry ln lhe rtaE.lurl.diction lor any Ellglble Recovery subJect to the recovery mecheniam a3 per S51.917(dxvil).
Name ol Reporting Carrier:FARMERS MUTUAL TEL CO LTD. . ID
Daniel Greig
O'gileny signd Dy Oanid Greig DN:cn:Danael
Greig,omail=dan@lmlc.@m.O=farmere mutual lel co ltd.'
id,l--Fruitund lO 83619. Daro:5/1 7/2019
Signature of Authorized Officer or employee:Date: 511712019
Printed name of Authorized Officer or employee:Daniel Greig
Title or position of Authorized Officer or employee:General Manager
Telephone number of Authorized Officer or employee:208-452-31 00
Study Area Code of Reporting Carrier 472221 Filing Due Date Ior this
form (mm/dd/yyyy)6l't7t2019
PgEons willfully making talso st.tEments on this forh can bo punishod by fine or forfeitu16 undar the Communicatlons Act of 1934,
47 U.S.C. SS 502, 503{b}, or flne o. imprisonment under Tltle '18 of thE Uniled States Code, I I U.S.C. S 1001.
Certification of Officer as to lhe Accuracy of the Data Reported for the Rate Floor Data
I ccrtlly that I am an orflcor of the reporting carderi my responslbllltics lncludc cnsuring lhe accuracy ol the actual rate floor data
reponed and, to tho best ot my knowledge, the lntomation reponed on thls rom ls accurate.
Nameof Reportinscarrier: pg;.1.pefS MUtUal TelephOne COmpany
oare: 0512912019
Printed name of Authorizod Officer: Daniel E. Gfeig
Title orposition of Authorized Officer Qgpgfal Managef
Terephone number of Authorized otticer 20A-452-2000
Study Area Code of Reporting Catrier 472221 L]Filing Due Date for this
fonn (mm/dd/yyyy)
0710112019
I certify that our company receives or is proiected to receive High Cost Loop Suppori (or Frozen High Cost Support that is based on
HCLS or High Cost Model Support) during the period July 2019 through June 2020, but has no monthly residential rates (plus
charges as delined) less than $18.00.
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