20200623Blackfoot Telephone CAF ICC Data.pdf

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Certification of Officer
to Authorize an Agent to File Data on Behalf of Reporting Carrir, ,'l -,! ..,-Ctiiffil$*t
I certify that (Name of Agent) John Staurulakis. Inc. (JSI) is authorized to submit information
reported on behalfofthe reporting carrier. I also certify that I am an officer ofthe reporting carrier;
my responsibitities include ensuring the accuracy of the data provided to the Authorized Agent; and,
to the best of my knowledge, the actual data provided to the Authorized Agent are accurtte.
i$2* iu,q e3 Plt 3: I
Name of Authorized Agent John Staurulakis, Inc. (JSI)
Blackfoot Telephone Cooperative, Inc.Name of Reporting Carrier
Date
1"ILl l*oSignature of Authorized Officer
Printed name of Authorized Officer (4{uvMueller
I'itle or position of Authorized Officer Chief Financial Officer
Telephone number or Authorized Officer. ( 406 ) 541 - 5424
Filing Due Date for this tbrm
(mm/dd/yyyy)482235 06116/2020Srudy Area Code of Reporting Carrier
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. $N 501, 503(b), or fine or imprisonment under Title l8 of the United States Code, l8 U.S.C. $ 1001.
Certilication of Officer as to the Accuracy of the CAF ICC Data Reported
I certify that I am an ofricer of the reporting carrier; my responsibilities include ensuring the
accuracy of the actual data reported; and, to the best of my knowledge, the information reported on
this form is rccurate.
Name of Reporting Carrier Blackfoot Telephone Cooperative, Inc.
Signature of Authorized Officer Date t /
1" /4 / utz.rt
Printed name of Authorized Officer U*duyMueller
Title or position of Authorized Officer Chief Financial Officer
Telephone number or Authorized
Officer.( 406 ) s4l - s424
Study Area Code of Reporting Carrier 482235 Filing Due Date for this form
(mm/dd/yyyy)06n612020
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. $$ 502, 503(b), or fine or imprisonment under Title l8 of the United States Code, l8 U.S.C. $ 1001.
Certification of Officer for Rate-of-Return Carrier Eligibility for CAF/ICC Recovery
I certify that I am an officer of the reporting carrier and that, to the best of my knowledge, the
reporting carrier on this form certifies that it has complied with Eligible Recovery $51.917(d) and
Access Recovery Charge $51.917(e) and is eligible to receive the CAF ICC support requested pursuant
to $51.9U(f).
Blackfoot Telephone Cooperative, Inc.Name of Reporting Carrier
Date I I
L l?h,:zoSignature of Authorized Officer
('{^{*MuellerPrinted name of Authorized Officer
Title or position of Authorized Officer Chief Financial Officer
Telephone nurnber or Authorized
Officer.( 406 ) s4t - s424
Filing Due Date for this form
(rur/dd/yyyy)482235 06/16t2020Snrdy Area Code of Reporting Carrier
Persons willfully making false statements on this form can be punished by fine or forfeiture under the Communications Act
of 1934, 47 U.S.C. $$ 502, 503(b), or fine or imprisonment under Title l8 of the United States Code, l8 U.S.C. $ 1001.
Certification of Officer for Rate-of-Return Carrier Not Seeking Duplicative Recovery
I certify that I am an oflicer of the reporting carrier and that, to the best of my knowledge, the
reporting carrier is not seeking duplicative recover) in the strte jurisdiction for any Eligible Recovery
subject to the recovery mechanism as per $51.917(dxvii).
Blackfoot Telephone Cooperative, Inc.Name of Reponing Carrier
Signature of Authorized Officer lDate t tI C lq lrcab
Printed name of Authorized Officer (--#"";Mueller
Title or position of Authorized Officer Chief Financial Officer
Telephone number or Authorized
Officer.( 406 ) s4t - 5424
06n6t2020Study Area Code of Reporting Carrier Filing Due Date for this form
(mn/dd/yyyy)4t2235
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. $g 502, 503(b), or fine or imprisonment under Title l8 of the United States Code, l8 U.S.C. $ 1001.