Capital Credits # A B C D E F G H I J K L M N O P Q R S T U V W Y Z H & H CATTLEH & H FARM SUPPLYH & R GROCERYH A N FARMSH O W RECOVERY HOMESH. & R. GROCERY PAY STA (EQUITH. A. SACK COMPANYH. O. W. RECOVERY HOMESH.A. SACK CO.HAAF JOYHABBESTAD ANNEMARIEHABEGGER WENDYHACKER VIRGINIA R. MHACKETT BENHACKETT DAVIDHADAWAY JERALDHADDEN CLEOHADDEN GARYHADDEN PALMERHADDEN STEPHANIE SHADLEY HAROLD RAYHAGAN ALFONZAHAGAN ALISONHAGAN B JHAGAN BILLHAGAN C. W.HAGAN DAN WHAGAN DAN W. PONDHOHAGAN ELIZABETHHAGAN FREDDIEHAGAN GEORGE S.HAGAN GREGHAGAN J. DONHAGAN JAMES DHAGAN JAMES JACKSONHAGAN JEFF DHAGAN JIMMY MHAGAN JOHN I.HAGAN JOHN M.HAGAN JOSEPH D.HAGAN KARENHAGAN LISAHAGAN LOUETTEHAGAN MELBAHAGAN MISS ELIZABETHAGAN PLUMBING & ELECTRICALHAGAN RAYMONDHAGAN ROGERHAGAN ROGER D.HAGAN SAMMYHAGAN SEAFOOD CO., INC.HAGAN SLATERHAGAN THOMAS D.HAGAN WALLACEHAGAN WALTERHAGAN WARRENHAGANS CECIL E.HAGANS ELDREDHAGANS ISABELLHAGANS J.E.HAGANS LEE HUGHHAGEMANN MICHAEL CHAGEN MARILYN PARRIHAGENSON DARWIN L.HAGIN AMYHAGIN BILLYHAGIN FARM PARTNERSHIPHAGIN JOHN W.HAGIN JOHNNYHAGIN KENHAGIN MACKHAGIN MARY ELLAHAGINS BETTYHAGINS CHARLESHAGINS FREDDIE JOEHAGINS J. E.HAGINS JERLENEHAGINS JEWELHAGINS MACK JR.HAGINS MARY DHAGINS ROSAHAGINS TIMOTHYHAGINS WILLIE JAMESHAINLEY DAVID A.HAIRE STEVENHALE CHARLESHALE ISAACHALFERTY MICHAEL J.HALL BILLY JRHALL CHARLIEHALL COLLISHALL CURTISHALL DENVERHALL DONNAHALL GEORGIA MAEHALL J MICHAELHALL JAMES E.HALL JIM DHALL JUANITAHALL JULIEHALL K BHALL LEEHALL M LHALL MABLEHALL MARCIAHALL NANCYHALL R. C.HALL R. E.HALL RUTHHALL SHADHALL THOMAS GHALL TRACIE L.HALL VERONICAHALL VICTORIA DHALL WILLIAM AHALL ZENDAHALLMAN BRYANHALLMAN EARLEHALLMAN S KHALLORAN PAUL JHAM DOUGLASHAM DOUGLAS JR. (HAM RICHARDHAMBY ANN GHAMILTON EARL D.HAMILTON KENNETH M.HAMILTON LEEHAMILTON MAXHAMILTON MAX J.HAMILTON MRS. PEARLHAMILTON PEARL MRS.HAMILTON SANDRAHAMLIN HENRY W.HAMLIN RICHARD E. JRHAMMERSMITH W. J.HAMMOND JOHN MICHAELHAMMOND ROGER L.HAMMONS CHARLESHAMMONS DOROTHYHANCOCK CHERYL J.HANCOCK DAVIDHANCOCK ERNESTHANCOCK JAMES F.HANCOCK JAMES WHAND HENRIETTAHAND JOHN JR.HANEY ROBERT WHANGLEY MICHELHANIE MICHAELHANKS JIMMY A.HANKS REXHANNA KEITHHANNA LHANNA TERESAHANNAFORD DANA LHARBESON LUCILLEHARBIN JOHN MHARBIN LINDAHARBIN NORMAN B. JR.HARDEE BENJAMINHARDEN LISA M.HARDEN M RHARDEN SHAMONKAHARDEN SHERRYHARDISON DALE F.HARDWICK BENJAMIN D.HARDY ANTHONYHARDY CLAUDEHARDY DEBRA BHARDY DELORES DHARDY HAZELHARDY JOE JRHARDY JOHNNYHARDY KAREN AHARDY MARY AHARDY ROSA BHARFORD FELTONHARGETT GLORIAHARGROVES HORACE MHARKINS R. J.HARLEY WYMANHARLIE ALVIRA JHARLIE EDDIE LHARLOW JAMESHARMON KARMAHARN E. C.HARN L. A.HARN LONNIEHARN RONALDHARN TERRYHAROLD HAGAN STOREHARPER BELLEHARPER BRANDONHARPER DAVID RHARPER JAMES ALANHARPER LYNNHARPER MRS. ANNIEHARRELL FRANHARRELL HUSTONHARRELL JACKIEHARRELL REBECCA D.HARRELL WILLIE H. JR.HARRELSON JOHNNYHARRELSON LEE RHARRELSON PATRICIA AHARRELSON TIMHARRELSON TODDHARRIS CURTISHARRIS DAVIDHARRIS DAVID A.HARRIS DAVID T.HARRIS GREG LHARRIS HAZELHARRIS JACKHARRIS JOE BHARRIS KEVINHARRIS LUTHERHARRIS MICHAELHARRIS MONALISA THARRIS PHILIP RHARRIS PHILIPPHARRIS TRACI LHARRISON AMANDAHARRISON CENIE MRS.HARRISON CHARLIE D.HARRISON CHRISTIE AHARRISON FURMANHARRISON LEOLAHARRISON M. E.HARRISON REV. E. L.HARRISON ROBERT LHARRISON RODELLEHARRISON ROSE ELLAHARRISON S. W.HARRON BILLHART ALFRED SR.HART DAVIDHART DOUGLASHART ELOISEHART H. TERRELLHART JHART J A JRHART J. A. (BARN)HART J. GARYHART JOEYHART JOHNHART JOHNNYHART JUDYHART KATIEHART LISA AHART PATTYHART ROBERT LHART STEPHANIE KHART WILLIAM JRHART WILLIAM SR.HARTLEY JASON LHARTLEY WILLIAM D. C.HARTSFIELD BOBHARVEY CARLTONHARVEY GREGORY LHARVEY RICHARD RHARVEY RONALD F. (CHHARVEY TERRIHARVILLE BRIDGET NHARVILLE BROOKS DHARVILLE HERMANHARVILLE KEEBLERHARVILLE KENNETH H.HARVILLE KIMBALLHARVILLE MELINDAHARVILLE MICHAEL JHARVILLE MISS NAOMIHARVILLE SAMHARVILLE VIRGILHARVILLE VIRGIL JR.HARVILLE VIRGIL K JRHARVILLE VIRGIL K. JR.HARVILLE VIRGIL KJRHARVILLE VIRGIL KJR.HARWELLL NATHASHMI ZIA HHASIB KAZIHASTINGS B. H.HASTINGS CHARLESHASTY NATHANHATCHEL YVONNEHATCHER GENEHATCHER REV. HOKEHATCHER RICHARD H.HATFIELD BETH A.HATFIELD JAMES H.HATHCOCK WADEHATTRICK BARRYHAUN RONALD W.HAVLE SARAHHAVRON J. Z.HAWKINS JAMESHAWKINS JAMES C.HAWKINS JAMES H.HAWKINS MELVIN C.HAWKINS VICKIEHAY CATHERINEHAYES ANDREWHAYES SCOTTHAYES WILLIAM KHAYGOOD GREGORYHAYGOOD L. E. FARMHAYGOOD ROBERT WHAYNES DAVIDHAYNES JAMESHAYNES REXHAYSLIP ELLEN JHAYSLIP JAMESHAYSLIP JAMES AHAYSLIP SERVICE STATIONHAYTER WILLIE P.HAYWOOD BEOLAHAZEN JOHAZZARD GINA CRAVENHEABERLIN WILLIAM "GARRHEADRICK JACKIE MHEADRICK KRISHEALTH MASTER HOME HEALTH CAREHEARD ELEASE EHEARTWOODHEATH BETTY WILLIAMSHEATH ESTATE OF CHARLES AHEATH HELENHEATH HELEN BHEATH HOMERHEATH IRMA MRS.HEATH JACKIE JR.HEATH JACKY JRHEATH JAMES D.HEATH JOSEPH NHEATH MRS. IRMAHEATH SHERRIHEATH VALDAHEATHCOCK ANGELA DHEATON ROGERHECHT THOMASHEFFERNAN IRENEHEIN STEVEN M.HEIPLE TRICIAHELD JOANNEHELFRICH HOLLEY MHELLER GLENDAHELLER KATHALEENHELMEYER THOMASHELMS CECILIAHELMUTH BECKYHELMUTH MRS. P. E.HELMUTH RANDYHENDERSON BEVERLY MHENDERSON GREGORYHENDERSON LINDSY P.HENDERSON SAMMYHENDERSON STEVENHENDLEY CODYHENDLEY D L SRHENDLEY EUSTIS L.HENDLEY JAMES AHENDLEY LINDAHENDLEY MACHINE SHOPHENDLEY MRS. ALICEHENDLEY RENDAHENDLEY TRAVISHENDLEY VIRGINIAHENDLEY WINTONHENDON LEWIS B.HENDRICK M. L.HENDRICKS GLYNN A.HENDRICKS JASONHENDRICKS JOHN E.HENDRIX ANNIE MAEHENDRIX BHENDRIX B. A.HENDRIX B. J.HENDRIX BETTE PHENDRIX BILLYHENDRIX BONNIEHENDRIX BRENDAHENDRIX BURCHHENDRIX CARLHENDRIX CARL WHENDRIX CARL W.HENDRIX CARLTONHENDRIX CAROL D.HENDRIX CHARLESHENDRIX CHARLIE H.HENDRIX CHRISHENDRIX CLYDEHENDRIX CRAIGHENDRIX CRAWFORDHENDRIX D WHENDRIX D. W.HENDRIX DANNYHENDRIX DANNY RHENDRIX DENISEHENDRIX DONNAHENDRIX DOROTHYHENDRIX DOROTHYHENDRIX DOROTHY EHENDRIX DOVEY F.HENDRIX DUPREEHENDRIX EARNESTHENDRIX ERMONHENDRIX FANNIEHENDRIX FARMHENDRIX FARM SHOPHENDRIX FAYEHENDRIX FEED AND SEED CO.HENDRIX FLORRIE I. MRHENDRIX FRANKLINHENDRIX GHENDRIX GARAGEHENDRIX GATSONHENDRIX GINA LHENDRIX GLADYSHENDRIX GLENN DHENDRIX GRACIE LHENDRIX GROC & GAS SPEAK EZYHENDRIX GROCERY COMPANYHENDRIX GROCERY PAY STATIONHENDRIX INMAN D.HENDRIX J. F.HENDRIX J. W.HENDRIX JAMES E. JR.HENDRIX JASONHENDRIX JEAN EHENDRIX JEANETTEHENDRIX JERRALHENDRIX JERRYHENDRIX JOEHENDRIX JOHN W.HENDRIX JOHN WJRHENDRIX JUNE EHENDRIX KASEYHENDRIX KATHYHENDRIX KATIEHENDRIX KEVINHENDRIX KOUNTRY KITCHENHENDRIX L. L.HENDRIX LAURAHENDRIX LEWISHENDRIX LONNIE L.HENDRIX LOUISEHENDRIX LUCIOUS JR.HENDRIX MRS. W. L.HENDRIX PERCELLHENDRIX RICKHENDRIX RITAHENDRIX ROBERT EHENDRIX SAMHENDRIX SAM L.HENDRIX SHELLYHENDRIX TALMADGEHENDRIX TARAHENDRIX TERRYHENDRIX THOMASHENDRIX THOMAS GARY SHOPHENDRIX TOMMYHENDRIX TOMMY H.HENDRIX TOMMY LHENDRIX TROY AJRHENDRIX U. H.HENDRIX ULEYHENDRIX WILLIAM R.HENDRIX WILLIAM WHENDRIX WILLIAM W.HENDRIX'S GROCERY & GASHENDRY BRUCE RHENLEY CARLHENLEY CARLTONHENLEY CONNIEHENLEY JACOB DHENRY ALBERT JRHENRY ALBERT JR.HENRY ANNHENRY CARLHENRY COLSON GARAGEHENRY FAYE GHENRY GLENN AHENRY LINDA LHENRY LYNETTE DHENRY MICHAELHENRY MICHEALHENRY OTISHENRY PHOEBE BHENRY RICHARD S.HENRY STEVEHENSLEY MELISSA AHENSLEY WILLIAM H. RAHERB J CHERB J CJRHERB THOMAS H.HERMAN KENNETH EHERNANDEZ CARLOSHERNANDEZ TEODULOHERNANDEZ THOMAS JJRHERNDON C MIIIHERNDON NORRIS D.HERRIN BETTYHERRIN C. SELBYHERRIN HEATHERHERRIN JAMES EHERRING DANNY L.HERRING MICHAEL DHERRING SHIRLEYHERRINGTON BETTYHERRINGTON JOHN RHERTH L AHESTER DEWEY LHESTER RUSSELLHETRICK GARYHEWATT DONALD WHEWELL JONI LHEWITT GLENDAHEWITT JOHN J.HEYWARD LIZETTAHIBSCHMAN L. A.HICE JAMES T.HICE RICHARD O.HICKMAN & SON'S GULF SERVICEHICKMAN AARONHICKMAN DONNIEHICKMAN H. C.HICKMAN J. LAMARHICKMAN JAMES JRHICKMAN LAMARHICKMAN RANDYHICKMAN TAMMYHICKORY HAMSHICKORY RIDGE FARMSHICKS CORA LEEHICKS DANIEL B. JR.HICKS LAMARHICKS WILLIAM MHIDDEN LAKE ENTERPRISESHIGGINBOTHAM AVAHIGGINHOTHAM JOANHIGGINS MELISSA MARIEHIGHFIELD WILLIAMHIGHSMITH CAROLYN JHIGHSMITH TIMOTHY VHIGHTOWER LONZAHILDE CHADHILDE RICHARDHILL AMOSHILL ANN LHILL ARTESIAHILL CHARLES W.HILL DENISEHILL DONALDHILL EARLEENHILL EDDIEHILL FREDERICK SRHILL G. T.HILL GERALD D.HILL HENRIETTAHILL HENRYHILL JHILL JESSIE SRHILL JIMMY B.HILL JOHNHILL JOHN M.HILL JOHNNYHILL MAE FHILL MARYHILL MAURYHILL MICHAEL J.HILL PRATT WHILL RICHARD O.HILL RONNIE R. JR.HILL RUTHHILL S WHILL SALLI S.HILL VIRGINIAHILL VIRGINIA QHILL WILLIAM JHILL WILLIEHILLEGAS DEANHILTON FRANKIE LEEHILTON JAMESHILTON MARGARETHILTON MYRAHILTON TRUMANHINDMAN DARYLHINES GARY L.HINES GEORGIA FHINKLE JAMES RHINSON JACK A. DSMHINSON JACKIEHINTON BOBBYHINTON J. H.HINTON J. L.HINTON J. L. SR.HINTON JESSE LJRHINTON MICHELLEHIRES KATHYHIRES RICHARD (BRYAHIRES WILLIE P JRHIRES WILLIE P. JR.HIRSCH & TUCKER LLCHOARD HAZELHOARD J RHOBBS DARTHOBBS DONNIEHOBBS ELTON DHOBBS JAMES A.HOBBS LORETTAHOBBS MICHAEL RHOBBS NANCY MARIEHOBBS RUTHHOBBS STANHOCH JOHNNY P.HOCK MARKHOCK MRS. GLORIAHOCKMAN CECILHODGE CLAUDIA EHODGE FREDDIE JRHODGE HARRY JRHODGE JAMES WHODGE KENNYHODGE LILLIE AHODGE LUCILEHODGE ROBERT LHODGE ROSAHODGES ALTONHODGES AMBERHODGES BETTYEHODGES BETTYE T.HODGES BEVERLYHODGES BILLY G.HODGES BILLY MHODGES BILLY M. (MOBHODGES BRENDAHODGES CAROLHODGES CHRISTYHODGES CLARISSAHODGES CLAUDEHODGES DAVID C.HODGES DONNAHODGES ERMA JHODGES F. WIGHTHODGES FARMHODGES GENOUS SHODGES GREG PHODGES J LHODGES JAMES NHODGES JIMMY AHODGES JOE G.HODGES JOHN THODGES JOHN THOMASHODGES JOSHHODGES KARL J.HODGES KENHODGES LESHODGES LISAHODGES LOISHODGES LUCILLE H.HODGES M. B.HODGES MALCOLMHODGES MIKEHODGES RAYHODGES RAYMOND G.HODGES ROBINHODGES T. A.HODGES TERESAHODGES TERRELLHODGES VIRGINIA EHODGES WADE C.HODGES WIGHTHODGES WILLIAMHODGES WILLINEHODGES WINNHODGES ZARA T. MRS.HOELL ROBERT CHOFFACKER JOHNHOFFMAN SANDRA JHOISINGTON MATTHEW RHOLBROOK MATTHOLBROOK MATTHEWHOLBROOK RICHARDHOLCOMB ROBERT D.HOLDER CHRISHOLDER TERRY LHOLIDAY BERNICEHOLLAND ANNIE KHOLLAND BOBBYHOLLAND HOMERHOLLAND JOELHOLLAND LAURAHOLLAND LELAHOLLAND TELLIE M.HOLLAND WARREN B.HOLLAND WILLIAM R.HOLLANDSWORTH MICHAELHOLLEY BRIANHOLLIFIELD WYLENE DHOLLIMAN DANIEL R.HOLLINGSWORTH ANNIE MAEHOLLINGSWORTH BETTYHOLLINGSWORTH BOBHOLLINGSWORTH D. C.HOLLINGSWORTH JUNIOR GHOLLINGSWORTH LOISHOLLINGSWORTH MAGGIE K. MRSHOLLINGSWORTH MARYHOLLINGSWORTH MIKEHOLLINGSWORTH P. A.HOLLINGSWORTH RAYHOLLINGSWORTH RUBYHOLLINGSWORTH TAMMYHOLLINGSWORTH TOYHOLLOMON STEPHEN W.HOLLOWAY CLAUDE JR.HOLLOWAY GARY AHOLLOWAY JESSEHOLLOWAY KERIHOLLOWAY L. R.HOLLOWAY LEONHOLLOWAY LEVONHOLLOWAY TERRE'HOLLOWAY WILLIEHOLMAN CINDY SHOLMES DOROTHY LHOLMES H. FREDERICKHOLMES INEZ MHOLMES JIMMYHOLMES L. A.HOLMES PEARLHOLMES SHERIHOLMES TIMOTHY RHOLT LESLIEHOLT NANCYHOLY ENA F.HOLY MRS. EDNA F.HOME CARE HEALTH DEPT.HOME HEALTH EQUIPMENTHOMES ROBERT W. MRSHONAKER BARBARAHONEY-DO QUICK CHANGEHONEYCUTT KEVINHONNERLAW WANDAHOOD H. L. SR. MRSHOOD J. O.HOOD JESSE J CONTRACTING &HOOD JOSEPH W.HOOD KENNETHHOOD LLOYD GHOOD SHIRLEYHOOK LEWIS W. SR.HOOK THOMAS GHOOK WILLIAM BARN LJRHOOKER CHARLES EHOOKER JAMESHOOKS DOY THOOKS JOE G.HOOKS LINDA DHOOKS TERRY FHOOPER ARTHUR E.HOOPER RON PHOPE BRUCEHOPE BRUCEHOPEK BARBARA AHOPEWELL BONNIE JHOPKINS CRAIGHOPKINS DOUGHOPKINS SUEHOPKINS TWANA LHORNE BECKYHORNE PHILHORNE WILBUR PHORNSBY RUSSELLHORTON CHARLES DORSEHORTON JAMES A.HORTON JEFFERY OHORTON RAYMOND GHORTON T. B.HORTON VIRGIL L.HORTON VIRGIL LSRHOSNER CYNTHIA KHOSSAIN MOHAMMADHOTCHKISS FOYHOTCHKISS HHOTCHKISS MRS. E. L.HOTCHKISS S DHOUSE ROBERTHOUSTON JEANETTEHOUSTON LEONHOWARD AG INCHOWARD ALICE FAYEHOWARD ANGELHOWARD BARBARA BHOWARD BEAULAH A.HOWARD BENJAMINHOWARD DAVID WHOWARD EDWARDHOWARD ELIZABETHHOWARD FREDDIE LHOWARD FREDDIE LEEHOWARD GARY FHOWARD GILBERT E.HOWARD GRADYHOWARD HAROLDHOWARD HARVEYHOWARD ISIAH JRHOWARD JAMES I.HOWARD JOHNHOWARD JOHN C FARMHOWARD JOHN C.HOWARD JOHN C.HOWARD JOHN C. CLUBHOUSEHOWARD JOHN C. JR.HOWARD JOHN S.HOWARD LEONAHOWARD MANDY MHOWARD MIKE EHOWARD MOTOR CO.HOWARD N. E.HOWARD OTISHOWARD R LJRHOWARD ROBINHOWARD SADIEHOWARD SUSAN MHOWARD THOMAS F.HOWARD WAYNEHOWARD WAYNE J.HOWARD YVONNEHOWARD'S HOUSEHOLD HANDYMANHOWELL B. H.HOWELL BRIANHOWELL CALVIN R. SR.HOWELL DELORES DHOWELL ERASTUSHOWELL JAMES SHOWELL JAMES WHOWELL JENNIFERHOWELL JOHN BHOWELL JOSIE MAEHOWELL MELVINHOWELL MIKEHOWELL MRS. DELMAR RHOWELL RAYHOWELL ROBINHOWELL SAMUEL CHOWELL TERESAHOWELL WHOWELL WILLHOWLE LANY A.HOYLE DAVID AHOYLE REV. J. REEVEHOYME LYLE JHUBBARD IKEHUBBARD J PHUBBARD KARENHUBERT EDENFIELD STOREHUBERT METHODIST CHURCHHUBNER SHARON K.HUCKABEE GAVINHUCKS DANIA BHUDDLE HOUSEHUDDLE HOUSE #299HUDGINS JAMES Z.HUDSON CONNIE AHUDSON DAVID REV.HUDSON DENISEHUDSON TARA DHUFF BENHUFF J. L.HUFF JACKIEHUFF JEFFERYHUFF JIMMYHUFF O. C.HUFF PAUL 4-7CAVHUFF PEARLHUFF ROBERTHUFF SIDNEY SRHUFFMAN VERNONHUGENSMITH LYNHUGGINS REV. W. L.HUGH JACKSON CONSTRUCTIONHUGHES BARBARAHUGHES CATHERINEHUGHES DONALD WHUGHES EVELYN FHUGHES F. W. MRS.HUGHES GRADYHUGHES MARIAHUGHES MIGUALHUGHES ROBERTHUGHES STEVEN D.HUGHES WILLIAM RHULME HEIDE SHULSEY FLOYD DHULSEY JACK GHULSEY JODYHULSEY JOEHULSEY LILLIE FHULSEY LISA LHULST CARLHULST ROBERT H.HULST RUTH EHUMBER BRENTHUMES RANDY WHUMPHREY CURTISHUMPHRIES FRANCESHUMPHRIES LEEHUMPHRIES LINDERHUNKO GERALD R.HUNNICUTT HOLLYHUNNICUTT SAMUEL T.HUNT JOHN HHUNTER CORA LEEHUNTER DONALDHUNTER JEFFERY RHUNTER JOHN WILLIE JHUNTER LONNELLHUNTER MINNIE PHUNTER PATRICIA AHUNTER VICTORIAHURST DEBORAHHURST GLENHURST HUNTER JHURST STEVEHUTCHENS P. THUTCHESON H. JHUTCHESON MARVIN FHUTCHESON SUSANHUTCHINS VIOLAHUTCHINSON ANGELAHUTCHINSON CARLHUTCHINSON HALHUTCHINSON MARK CHUTCHINSON RICHARD CHUTCHISON HAROLDHUTTO ANGIEHYNKO GERALD RHYNKO GERALD R. BULLOCH TELEPHONE COOPERATIVE CLAIM FORM Existing Member Name(Required) First Last Existing Street Address Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Updated Name(Required) First Last Updated Street Address(Required) Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Account NumberMember NumberPhone NumberIn conjunction with the retirement of capital credits prior to 1990, I hereby make the following certification regarding my status or my entities status prior to receiving our patronage refund: I am a residential customer and have not deducted the cost of communication service on any tax return for the years prior to 1990. The qualified Member above is deceased and I am claiming the Patronage refund on their behalf. I have included a death certificate and a court document to verify that I am qualified to receive the refund and will distribute the proceeds according to the laws of Georgia. My entity is incorporated under the corporate laws of Georgia and our state issued control number below. Control NumberFile UploadMax. file size: 128 MB. Is there anything else you'd like to tell us?
