20200623Freemont Telcom CAF ICC Data.pdf

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RECEIVEE
2?il?CI JUil 23 Pt{ 3:
Certification of Officer ,,::i ! r : - n, ihr ra
to Authorize an Agent to File Data on Behalf of Reporting Carriqr i 'll ,ilj''Ctifiiifif
I certify that (Name of Agent) John Staurulakis. Inc. (JSD is authorized to submit information
reported on behnlfofthe reporting carrier. I also certify that I am an oflicer ofthe reporting carrier;
my responsibilities 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 tccurate.
John Staurulakis, Inc. (JSI)Name of Authorized Agent
Name of Reporting Camer Fremont Telcom Co.
Signature of Authorized Oflicer Date, t
blrt lz:zt:l
Printed name ofAuth oar"aomr"TUdacey Mueller
Title or position of Authorized Officer Chief Financial Officer
Telephone number or Authorized Olficer. ( 406 ) S4l - S4Z4
Study Area Code of Reporting Canier Filing Due Date for this tbrm
(mm/dd/yyyy)472222 061t6/2020
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. lj 1001.
Certification of Officer as to the Accuracy of the CAF ICC Data Reported
I certify that I am an officer of the reporting carrier; my responsibilities include ensuring the
&ccuracy of the actual data reported; and, to the best of my knowledge, the information reported on
this form is accurate.
Name of Reporting Carrier Fremont Telcom Co.
Signature of Authorized Officer 7'a b lqDate )ozt\
Printed name of Authorized Officer Stacey Mueller
Title or position of Authorized Offrcer Chief Financial Officer
Telephone number or Authorized
Offrcer.(406) s4l -s424
Filing Due Date for this form
(mm/dd/yyyy)472222 06fi6t2020Snrdy Area Code of Reporting Czu'rier
Persons willfully making false statements on this form can be punished by fine or forfeinrre under the Communications Act
of I934, 47 U.S.C. $g 502, 503(b). or fine or imprisonment under Title l8 of the United States Code, l8 U.S,C. li 1001.
Certification of Officer for Rate-of-Return Carrier Eligibility for CAF/ICC Recovery
I certify that I am an ollicer of the reporting carrier and that, to the best of my knowledge, the
reporting crrrier on this form certilies 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 S51.917(f).
Name of Reporting Carrier Fremont Telcom Co.
DateSignature of Authorized Officer
Printed name of Authorized Officer \{u-;Muelter
Title or position of Authorized Officer Chief Financial Officer
Telephone number or Authorized
Offrcer.(406) s4t - s424
Study Area Code of Reporting Carrier 472222 Filing Due Date for this form
(mr/dd/yyyy)06fi6t2020
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. $s\ 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 officer of the reporting cnrrier ond that, to the best of my knowledge, the
reporting carrier is not seeking duplicative recovery in the state jurisdiction for any Eligible Recovery
subject to the recovery mechanism as per $51.917(dxvii).
Name of Reporting Carrier Fremont Telcom Co.
Signature of Authorized Officer Date t tt, lt+lz^tzo
Printed name of Authorized Office, (-Kucey Mueller
Title or position of Authorized Ofticer Chief Financial Officer
Telephone number or Authorized
Officer.(406) s4t - s424
Study Area Code of Reporting Carrier 472222 Filing Due Date for this form
(nuniddryyyy)06n6t2020
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.