20190614Project Mutual Telephone CAF ICC.pdf

T-q-0,
I certify that I am an oflle. of the rcportlng carlsr; my .esponsibilltles lnclude ensuring the accu,acy ollhe actual data ,epoded;
and. to tho best ol my knowledge, the lnformatlon rcporled on thls fom la accurate.
Certitlcatlon of Officer as to the Accuracy of the CAF ICC Data Reportod
PROJECT MUTUAL TEL. COOP, ASSN,Name of Reporting Canier:
Date: 5l?212019
Dioitally siond by Rick Hardor ON:cn=Rick
Hardor.email:rharder@pmt.@p,O:prcjecl mutual tel.
cmp- assn..E , OeG:512212019
Rick Harder
Signature of Aulhorized Officer:
Rick HarderPrinted name of Authorized Officer:
Title or position of Authorized Officer:CFO/Treasurer
TelephonenumberofAuthorizedOfficer: 208-434-7124
472231 Filing Oue Date tor this
form (mm/dd/yyyy)6t1712019Study Area Code of Reporting Carier
PoEons wllltully maklng false itatoments on thls ,orm can be punished by tino or torteiluc und9, tho Communic.tions Act of '1934,
47 U.S.C. S! 502, 503(b), or flne or imprlsonment unde. Tltle 1E of tho Unlted States Code, 'lE U.S.C. S 1001,
-l;
= 13,*,tt C- Tilz*ffico-"f C-)
^lJ -r m
O.= IEE= g
U,A ;cf, cnO-l
TO BE COMPLETED BY THE REPORTING CARRIER.
TO BE COMPLEIED BY THE REPORTING CARRIER. IF AN AGENT IS FILING DATA ON THE CARRIER'S BEHALF:
Certlflcatlon of Offlcer to Authorlze an Agent to Flle Oata Reported on Bahalf of Reportlng Carrler
I certlty thal (Name o, Agent)National Exchange Carriers Association,lnc.l8 aulhorlzed to submlt tho lnformatlon eported on
behalf ot lhe .eponing car.ier. I al8o certlt th.t I am an ofrice. of the rcporting ca.rior; my regponsabilities include ensuring the
accuracy ofthe data provided to the Authorlzsd Agent; and, to ths best of my knwoledge, the actual data provided to the Authorl.ed
Name of Authorized Agent National Exchange Carriers Association, lnc.
Name of Reporting Carrier:PROJECT MUTUAL TEL. COOP. ASSN.
Rick Harder
DEilaly signed by Rick Harder ON]cn:Rick
Hardor,email=[e-mail],O=projocl mul!al lel coop.
assn..l. . Dare:5/2212019
Signature of Authorized Offic€r:Date: 512212019
Printed name of Authorized Officer:Rick Harder
Title or posilion of Authorized Officer:CFOffreasurer
Telephone number of authorized ofllcer:208-434-7124
Study Area Code of Reporting Carrier 472231 Filing Due Date for this
form (mm/dd/yyyy)6t17t2019
Po.sons willfully maklng talse stalgments on this fo.m can bs punlshed by flno o. torfoiturg under lhe Communicatlons Act ot 1934,
47 U.S.C. gS 502, 503(b), or flne or imprlsonmont undor Tltlo l0 of tho United Statcs Codo, l8 U.S.C. S 1001.
TO BE COMPLETED BY AN OFFICER OF THE REPORTING CARRIER
Certitlcalion of Officer for Rate{t-Return Carrier Eligibility for CAF/ICG Recovery
I certlfy lhat I am an offlst o, the cportlng carrlel and that, to the bcst of my knowledge, the reportlng carrler on thlg form
cedlfle. thal lt har complled with Ellglblr Recovery S51.917(d) .nd Acccta Recovery Charge S51.917(e) and is eligible to,eceive the
CAF ICC !upport Equorted puEuant to S51.917(0.
Name of Reporting Carrier:PROJECT I\4UTUAL TEL. COOP. ASSN,
Rick Harder
Ogitally sio@d by Rick Harde, DN:cn:Rick
Harder,email:rha.der@pml.@op,O:projecl mulual lel.
coop. assn.,li, oate:s 12212019
Signature of Authorized Ofiicer or employee:Date: 512212019
Printed name ol Authorized Offier or employee:Rick Harder
Title or position of Authorized Officer or employee:CFO/Treasurer
Telephone number of Authorized Officer or employee:208-434-7124
Study Area Code ot Reporting Carrier 472231 Filing Due Oate for this
fom (mm/dd/yyyy)6t17t2019
PgEons willtully maklng falso statoments on thls form can bs punlahod by tine or rorfeilurc unde, thg Communlcations Act of 1934,
47 U.S.C. SS 502, 503(b), or flns or lmprlronment unde. Tltle 18 of the Unlted States Code, 'lE U.S.C. S 1001,
I
TO BE COMPLETED BY AN OFFICER OF THE REPORTING CARRIER
Certlfication of Offlcer for Rate{f-Return Carier Not Seeking Duplicative Recovery
I certify that I am an ofll@. of ahe rcportlng ca.rier and that, to the best oI my knowledge, lhe Eportlng car.ie. is not seeking
dupllcltlvc rccovery ln the date rurbdlcllon ,o, any Ellglble Recovery sublect to the recovery mechaniam as per S5'1.9'17(dxvii).
Name of Reporting Carier: PROJECT MUTUAL TEL. COOP. ASSN.
Rick Harder Oigihlly signd by Rick Hader DN:cn=Rict
Harder,email=rharder@pmt.@p,O:prcjst mulual tol.
@oO- ass6-,1: . Dab52n019
Signature of Authorized Ofiicer or employee:Dato: 512212019
Printed name of Authorized Officer or employee:Rick Harder
Title or position of Authorized Officer or employee:CFOffreasurer
Telephone number of Authorized Officer or employee:208-434-7124
Study Area Code of Reporting Carri€r 472231 Filing Due Date for this
form (mm/dd/yyyy)6t17t2019
P9,!on! willlully making talse stalgmgntg on this fotm can bo punished by fine o, torfuiture under the Communic.tions Act ot 1934,
47 U.S.C. SS 502, 503(b), or flne o. lop.lsonment under Tltle '18 of the United States Code, lE U.S.C, S 1001.