20190614Rural Telephone CAF ICC.pdf

TO BE COMPLETED BY THE REPORTING CARRIER,
Certlflcatlon of Offlcer as to the Accuracy of the CAF ICC Data Reported
I ccrllry thlt t am an offlcar o, the ,eponlng cerrlor; my rasponslbllltles lnclude ensurlng lho accuracy of ths actual data teported; !nd, to tho bost ot my
knowlcdgg, tha Informatlon roported on lhls form lc accurate.
Nams or Rm,6m s*n"rRural Telephory4pompany - I q
o
Titl6 or Dosllion ofAulhodz€d o*"rMce-President
reteohono n$nb6r of Auttutzad ofllc"" (208 360-261 4d.
Studv Area code of Reoorllno Canlor lnzzrs ltf $ilfl'#Jffiiterorthrsrorm Jue 1? 2019
Porsons wlllfully maklng false stalements on lhis form can bo pudshed by ,lne or forfelture und6r th6 Commmications Act of 1934, 47 U.s.C. SS 602, 603(b), or fina or
lmprlsonmsnl und8r Tltl6 '18 ol tho United States Codo, 18 U.S.C. S 1001.
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Carrier Cert
TO BE COMPLETED BY THE REPORTING CARRIER, IF AN AGENT IS FILING DATA ON THE CARRIER'S BEHALF:
Certlflcatlon of Offlcer to Aulhorize an Agent to Flle Data Reported on Behalf oI Reporting Carrler
lc*ll'ylh!t(N!meorAo.n0kauthoilzodtosubmlllh.lnlo.m!tior,opod€donbchalfofth€
ropodlng clrder I al:o eilly lhlt l rm rn otrlctl oflhr rsporlln! o.rl0r; my tosponslblllllor lnclude .nsurlng tho accuraoy ot lhe drls provldod to lho Aulhorlzod
Agont; !nd, to tha bsit of my knowladge, lha actull dtlo provtdcd to lho Authotlrrd Ag€nt err acourate.
Name of Au(ho.b6d iros4 National Exchange Carrier Association, lnc, (NECA)
Name orRqpor,ns ".,,nrRural
f e|€phottp-,e,psnpaly --!D
Oflicor D,n05124119
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366--261
St0dy Ar@ Cods of REportkro Car.kr l+tzzzz lfl$$iffi*:l1r,,";#'orrh,s
rom June l7 2019
P€Bons v/ffully maklng ,alsB statemsnts on tlls form can bo punishod by ,ina or lorf€lturo undor lho Communlcatlons Aot of 1934. 47 U.S.C. SS 502, 503(b), or nno or
imprbomont undsr Title 18 o[tho Unltod Slates Gode, 18 U,S.C. S 100,1,
fol€Dhom numbsr of Arnlsrlad Omca[
TO BE COMPLETED BY AN OFFICER OF THE REPORTING CARRIER
Certlflcatlon of Offlcer for Rate-of-Return Carrier Ellgibillty for CAFTICC Recovery
I ccnfy that I am rn ofiiGer of tho reponht G.nlor and that, to the bert of my lnowledge, the repo,tlng cEiller on thls form certlfles that lt has
complied wlth Ellgblo Recowry 551.917(d, 8nd Accesr nocovery Chirle 051.917(e) and lt ellglble to r€colvs the CAF lCC.lpport requestcd pursuant
to f5r.s17(0.
Nam or Reoorrino 6,o,", Ru ra I TelepJtgn g, Com pany - I D
05124t19
n6me M
Tsre or posllon or anrhorrzed office, Vice-President
reteohona numbor of euthort2ed ofi car, (20p) 366-?S1 4
l+tzztt l$$$}ffif*,m.mtoFo,thisromStudy Aroa Code ot ReDorllno Garder
Jon6 17 2019
Personr willfully mrklng frl3e 3t.l.menls on thlr Iorm can be punhhod
503(b), or flno or lmpilsonmont undor Tllle
by
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flno or lorfolture undor tho Communlcstlons Act of 1934 .17 U.S.C. SS 502,
ol tha Unlted Slalo! Code, r8 U.S.C. S 1001,
TO BE COMPLETED BYAN OFFICER OF THE REPORTING CARRIER
Gerlification of Officer for Rate-of-Return Carrier Not Seeking Dupllcallve Recovery
lcodtfythetlamanofflcerofthereportlngcarrlerandthat,tothobertormyknowledge, thlsr€portln8C.rrierlsnotseeklngdupllcatlverecoveryln
ths ststGiurl3dlctlon for any Ellglble Recovery subr6ct to the recovery mechanltm as per 51,9u(dtlvn).
Name or Roporilno "*"rRu
ral Telep[gq e-Com pa ny - I D
sulhorlzed omc€r 05124119
Tltlo or Dosltlon ofauthorizod offlcer Vice-President
r€roc.ne numb* or authodzod orffcsr' (2qB) 366-?;6.1 4
luzzse ltffii$##l;;.;7.:,mteror,hisrormStudvArea Code ol REoorllno Canler
June 17 2019
Perronr wlllfully maklng fal.o stltaments on thls lorm can be punlehed hy tlhe or folfolturo undor lho Communlcallona Acl o, 1034, .t7 U.s.C. $g 502,
603{b), oi llnc or lmprltonm.nt undot Tllle 18 oflhc Unllcd Stitos cod., l8 U,S.C. $ 1001.
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