20200623Fremont Telcom CAF ICC Data.pdf

Certification of Officer
to Authorize an Agent to File Data on Behalf of Reporting Carrier
I certify that (Name of Agent) John Staurulakis. Inc. (JSD is authorized to submit information
reported on behalfofthe reporting carrier. I also certify that I am an officer ofthe reporting crrrier;
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 lre eccurate.
John Staurulakis, Inc. (JSI)Name of Authorized Agent
Name of Reporting Carrier Fremont Telcom Co.
Signature of Authorized Officer Date, t
blq lzaa:
Printed name o f Authorized offi cef
/ V{u"y M uel I er
Title or position of Authorized Officer Chief Financial Officer
Tetephone number or Authorized Oflicer. ( 406 ) 541 - 5424
Study Area Code of Reporting Canier Filing Due Date for this tbrm
(mmidd/yyyy)472222 06/16t2020
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. $$ 502, 503(b), or fine or imprisonment under Title l8 of the United States Code, l8 U.S.C. $ 1001.
Certification of Oflicer as to the Accuracy of the CAF ICC Data Reported
I certify that I am an officer of the reporting carrier; my responsibilities include ensuring the
lccuracy of the actual data reported; andn to the best of my knowledge, the information reported on
this form is accurate.
Name of Reporting Carrier Fremont Telcom Co.
Signature of Authorized Officer A.(?l,/Date
) O 2t{\
Printed narne of Authorized Officer
vzt--f-
Stacey Mueller
Title or position of Authorized Officer Chief Financial Officer
Telephone number or Authorized
Officer.(406) s4r -5424
Filing Due Date for this form
(mm/ddiyyyy)472222 06fi6t2020Srudy Area Code of Reporting Carrier
Persons willfully making false statements on this form can be punished by fine or forfeiture under the Communications Act
of 1934, 47 U.S.C. $$ 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 Eligibility for CAF/ICC Recovery
I certify that I am rn ollicer 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 pursutnt
to $5l.el7(f).
Name of Reporting Carrier Fremont Telcom Co.
Signature of Authorized Officer Date
Printed name of Authorized Officer \{ey Mueller
Title or position of Authorized Officer Chief Financial Officer
Telephone number or Authorized
Officer.( 406 ) s4t - s424
Study Area Code of Reporting Carrier 472222 Filing Due Date for this fbrm
(mm/dd/yyyy)06fi612020
Persons willfully making false statements on this form can be punished by fine or forfeiture under the Communications Act
of 1934, 47 U.S.C. g$ 502, 503(b), or fine or imprisonment under Title l8 of the Uniled States Code, l8 U.S.C. |i l00l.
Certification of Officer for Rate-of-Return Carrier Not Seeking Duplicative Recovery
I certify that I am an officer of the reporting carrier and that, to the best of my knowledgeo the
reporting carrier is not seeking duplicative recovery in the state jurisdiction for any f,ligible Recovery
subject to the recovery mechanism as per $51.917(dXrii).
Name of Reporting Carrier Fremont Telcom Co.
Signature of Authorized Officer Date I IL" lL+ l2nzO
Printed narne of Authorized Officer
( -/C/.- Stacey Mueller
Title or position of Authorized Ofticer Chief Financial Officer
Telephone number or Authorized
Officer.(406) s4t-s424
Study Area Code of Reporting Carrier Filing Due Date for this form
(nun/dd'yyyy)472222 06n6t2020
Persons rvillfully making false statements on this tbrm can be purrished by fine or forfeiture under the Communica(ions Act
of 1934, 47 U.S.C. $s\ 502, 503(b), or fine or imprisonment under Title l8 of the United States Code, 18 U.S.C. $ 1001.