20240715Blackfoot Telephone Cooperative Inc CAF ICC Form.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. (JSI)is authorized to submit information
reported on behalf of the reporting carrier. I also certify that I am an officer of the 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 accurate.
Name of Authorized Agent John Staurulakis,Inc. (JSI)
Name of Reporting Carrier Blackfoot Telephone Cooperative,Inc.
Signature of Authorized Officer Date Date 2024
Printed name of Authorized Officer Stacey Mueller
Title or position of Authorized Officer Chief Financial Officer
Telephone number or Authorized Officer. (406) 541-5000
Study Area Code of Reporting Carrier 482235 Filing Due Date for this form 06/17/2024
(mm/dd/yyyy)
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 18 of the United States Code, 18 U.S.C. § 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
accuracy of the actual data reported; and,to the best of my knowledge,the information reported on
this form is accurate.
Name of Reporting Carrier Blackfoot Telephone Cooperative,Inc.
Date
Signature of Authorized Officer S ?eza&', Date 024
Printed name of Authorized Officer Stacey Mueller
Title or position of Authorized Officer Chief Financial Officer
Telephone number or Authorized
Officer. (406) 541-5000
Study Area Code of Reporting Carrier 482235 Filing Due Date for this form 06/17/2024
(mm/dd/yyyy)
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 18 of the United States Code, 18 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§51.917(f).
Name of Reporting Carrier Blackfoot Telephone Cooperative,Inc.
Signature of Authorized Officer s Date Date 024
Printed name of Authorized Officer Stacey Mueller
Title or position of Authorized Officer Chief Financial Officer
Telephone number or Authorized
Officer. (406) 541-5000
Study Area Code of Reporting Carrier 482235 Filing Due Date for this form 06/17/2024
(mm/dd/yyyy)
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 18 of the United States Code, 18 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 carrier and 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(d)(vii).
Name of Reporting Carrier Blackfoot Telephone Cooperative,Inc.
Signature of Authorized Officer 5 Date
6/10/2024
Printed name of Authorized Officer Stacey Mueller
Title or position of Authorized Officer Chief Financial Officer
Telephone number or Authorized
Officer. (406) 541-5000
Study Area Code of Reporting Carrier 482235 Filing Due Date for this form 06/17/2024
(mm/dd/yyyy)
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 18 of the United States Code, 18 U.S.C. § 1001.

Certification of Officer
Final Audit Report 2024-06-10
Created: 2024-06-10
By: Michelle Owens([e-mail])
Status: Signed
Transaction ID: CBJCHBCAABAAwHbR_z_CPZdL34PY30-pfMgH1ty9K1J2
"Certification of Officer" History
Document created by Michelle Owens ([e-mail])
2024-06-10-5:19:07 PM GMT
Document emailed to Stacey Mueller([e-mail])for signature
2024-06-10-5:19:12 PM GMT
Email viewed by Stacey Mueller([e-mail])
2024-06-10-5:29:13 PM GMT
Document e-signed by Stacey Mueller([e-mail])
Signature Date:2024-06-10-5:29:26 PM GMT-Time Source:server
Agreement completed.
2024-06-10-5:29:26 PM GMT
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