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 M C C AM C C AM C C AM C C AM C C AM S I SUPPLY, INC.M S I SUPPLY, INC.M. E. GINN CO.MAC'S PACKAGE SHOPMACCAUGHELTY, JODY R.MACCAUGHELTY, T. C.MACCAUGHELTY, T. C.MACCAUGHELTY, T. CAMERONMACEDONIA BAPTIST PAST.MACEDONIA BAPTIST PASTORIUMMADDMADDMADDEN PENNY MMADDOX, AMANDA K.MADRAY, CLINTMAGNOLIA BAPTIST CHURCHMAHARREY JOE TMAHER KATHYMAINER OLIVERMAINER OMMIEMALLARD CHARLES FARMSMALLARD CHARLES RMALLARD EDWARDMALLARD GEORGE WMALLARD JIMMY EMALLARD MARGARETMALLARD S. S. PAY PHONEMALLARD SERVICE STATIONMALLARD, DENVERMALLARD, DONNIEMALLARD, VIRGINIA K.MALLARD, WALTER H.MALLORY, MRS. AMYMALOY S WMALOY, PAUL I.MALPHUS SAMUELMANCEL, MARGIEMANLEY, V.W.MANLY, H.D.MANN, W. W.MANNING HARRY & LESLEYMARCIEL MIKEMARICLE, WILLIAMMARICLE, WILLIAM E.MARICLE, WILLIAM E.MARKER, N. M.MARKHAM JACQUELYNMARKS, J. J.MARKS, ROBERTMARLOWE TOMMY LMARSH JEREMY KEITH & RYANMARSH JUDIEMARSH VICKIMARSH, EUNICEMARSH, H. V.MARSH, HERMAN PONDHOUSEMARSH, JERRY D.MARSH, JIMMYMARSH, MARIEMARSH, MARIEMARSH, NANCYMARSH, RALPHMARSH, RALPHMARSH, RICKEYMARSH, RUFUS SR.MARSH, TRACYMARSH, TROYMARSH, TROYMARSH, TROYMARSH, TROYMARSH, VICKIMARSHALL, GEORGE F.MARSHALL, PAULINEMARSHALL, WILLIAM R. IIIMARTIN AUDREYMARTIN BOBBY DMARTIN BODY SHOPMARTIN C MMARTIN CRAIGMARTIN DRAYFUSMARTIN JOHN O JRMARTIN JOSHUAMARTIN LEROYMARTIN MARIETTA AGGREGATESMARTIN RETHAMARTIN RONALD D.MARTIN TINAMARTIN WILLIAM FMARTIN, ANTHONYMARTIN, BILLY JOEMARTIN, BILLY JOEMARTIN, BOBBY FARMMARTIN, BOBBY M.MARTIN, BRADMARTIN, C. J.MARTIN, C. TOMMYMARTIN, CHARLIE T.MARTIN, CLAUDE D.MARTIN, CLIFF LAUND. & DRY CLEMARTIN, DONALDMARTIN, DONALD R.MARTIN, DOT K.MARTIN, EDDIE LEEMARTIN, ELMA N.MARTIN, G. DONALDMARTIN, G. DONALDMARTIN, IRIS K.MARTIN, J. L.MARTIN, J. OSCARMARTIN, J.G.MARTIN, JAMESMARTIN, JANICEMARTIN, JOE B.MARTIN, JOHN O. FARMMARTIN, JOHN P.MARTIN, MARION BIRDMARTIN, MR. C. J. - FARMMARTIN, MRS. C.J. (FARM)MARTIN, MRS. M. P.MARTIN, P.F.MARTIN, PAULMARTIN, TEWMARTIN, TOMMYMARTIN, TONYAMARTIN, W. E.MARTIN, WILLIAM F.MARTIN'S AUTO & EQUIP. REPAIRMARTINEAU, MARKMARVIN ORR GRO.MARYANNA'S WORKSHOPMASHBURN, SHIRLAMASK, J. MICHAELMASON ANGELAMASON MARIE SANDERSMASON WILLIAM GARYMASON, SCOTTMASOPUST M GMASSEY, GRACE H.MATHEWS, BERNARD, JR.MATHIS, ALMA A.MATHIS, CLAYTONMATHIS, DAVID M.MATHIS, RICHMATNEY, JEARLDMAUNEY, ANNIE M. MRS.MAUPIN, T.C.MAURC'S IMP. PHOT. STUDIOMAURO, ALBERTMAY, JOEMAY, MRS. SHELLYMAYER, JEFFERYMAYERS, W. B.MAYFIELD, GORDONMAYNARD, JOSEPH E.MAYO, BRENDA P.MAYS, JOHNMAYS, JOHN FORDMCALLISTER C B JR LT COLMCBRIDE BILLYMCBRIDE ELIZA JMCBRIDE ELMA LEEMCBRIDE GREGORYMCBRIDE GREGORYMCBRIDE JENNY & JAMESMCBRIDE JOHNMCBRIDE PEGGY EMCBRIDE WALLACEMCBRIDGE, CARRIEMCCA ATT: NATIONAL ACCTMCCA ATT: NATIONAL ACCT.MCCA ATT: NATIONAL ACCT.MCCALL DAVIDMCCALL JAMES JMCCALL RONALDMCCALL THOMAS ENG. CO. INC.MCCALL, MRS. J.E.MCCANN, CHARLES H.MCCART JAMES R.MCCART, RODNEYMCCARTHY, A. C., JR.MCCARTHY, CHRISMCCARTHY, CHRISMCCARTHY, JOHNMCCARTHY, ROBERT F.MCCARTHY, WALTERMCCARTY GROCERYMCCARTY'S GRO.MCCASKILL, BRUCEMCCAULEY JUDYMCCELLAND, W. L.MCCLAIN JAMESMCCLINTON, LEEMCCLOUDEN, HERMANMCCLURE, KENNETH B.MCCLURE, W. R.MCCOLLOUGH, DONALD W.MCCOLLUM GERTRUDEMCCOLLUM ROSCOE JRMCCOLLUM, ALFREDMCCOLLUM, MICHAELMCCOLLUM, NETTIE MAEMCCOLLUM, NETTIE MAEMCCOLLUM, ROSCOEMCCOLLUM, WALTERMCCOMB RICHARD & BARBARAMCCORD, CLARENCEMCCORKEL, LARREMCCORKEL, RICKYMCCORKLE CONRADMCCORKLE RAYMCCORKLE, CLEVEMCCORKLE, JERRYMCCORKLE, MRS. A.C.MCCORKLE, TERRYMCCORKLE, TORIAMCCORMICK, HARRYMCCORMICK, JIMMCCOWN MATTMCCOY, CLARENCEMCCRACKEN, DONALD A.MCCRAE, ANDREWMCCRARY WILLIEMCCRARY, PATRICKMCCRAY, BILLY EARLMCCRAY, GRADY A.MCCUBBINS JESSE E SR MRSMCCULLIN, ROBIN S.MCCULLOGH, WM. R.MCCULLOUGH, DONALDMCCULLOUGH, EUGENEMCCULLOUGH, GARFIELDMCCULLOUGH, HENRYMCCULLOUGH, WILLIAMMCCULLOUGH, WILLIAMMCCUMBERS CLAYTONMCCUTCHEON, JOHN W.MCDADE, FRANK L.MCDANIEL B JMCDANIEL CHADMCDANIEL EDGAR L JRMCDANIEL EDITHMCDANIEL LILLIANMCDANIEL MICHAELMCDANIEL, DERRELL S.MCDANIEL, DERRICK N.MCDANIEL, GENE D.MCDONALD E LMCDONALD, FARRIS C. JR., PASTOMCDONALD, H. E.MCDONALD, H. E.MCDONALD, HARLEY E.MCDONALD, JAMES A.MCDONALD, KEVIN DR.MCDONALD, ROGER A.MCDONALD, W. PAULMCDOWELL, RICHARD B.MCDUFFIE, LARRYMCELMURRAY, J. NOLANMCELVEEN ALLEN HMCELVEEN DAVIDMCELVEEN FRANCES DMCELVEEN L EUGENEMCELVEEN MIKE JR.MCELVEEN MONETTEMCELVEEN PONDMCELVEEN, A. F.MCELVEEN, HAROLD C.MCELVEEN, HOMER C.MCELVEEN, JAMES F.MCELVEEN, JOHN W.MCELVEEN, KENNETHMCELVEEN, KENNETHMCELVEEN, LOUISEMCELVEEN, LYNNE B.MCELVEEN, NINAMCELVEEN, THEOMCELVEEN, W. LEEMCELWEE KIMBERLY R.MCFADDEN, FRED B., JR.MCGAHEE, LINDAMCGAHEE, LINDAMCGEE BRIAN TMCGILL, LAFILS A.MCGINN ROBERTMCGLAMERY MRS WALTER E SRMCGLAMERY, MICHAELMCGLAMERY, MIKEMCGLAMERY, MIKEMCGLAMERY, MIKEMCGLAMERY, W.MCGONIGAL JANEMCGOWAN, MIKEMCGRADY JACKIEMCHUGH KEITHMCINROY, A. H.MCKANNA E DMCKEEHAN RICHARDMCKEEHAN, J. E.MCKEVER, JESSIEMCKINNEY CHRISTOPHERMCKINNEY J DMCKINNEY KEITH NORMANMCKINNEY LARRY CHILDRENMCKINNEY, JAMES D., JR.MCKINNEY, KEITH N.MCKINNEY, LESLIE R.MCKINNON, RONNIEMCLAUGHLIN, JAMES E.MCLAURIN, D. K.MCLEAN, MRS. CARL GRADYMCMAHAN GLENNMCMAKIN BMCMICHEN, JAMESMCMILLAN WILLEENMCMILLAN, CHARLES A.MCMILLIAN ESTHERMCMILLIAN WILLIE JAMESMCMILLIAN, ALEXANDERMCMILLIAN, WILLIAMMCMILLIN, DELMA F.MCMULLEN, MARVIN H.MCNAMAR, ELTON C.MCNAMAR, JULIEMCNEAR, FLORINEMCNEELY IKEMCNEELY, JOHN L.MCNURE, RICKYMCNURE, W. F. (GARAGE)MCNURE, WILLIAM JR.MCPHATTER THELMONMCPHERSON, REBECAMCRAE, JOHN H.MEAD, TOMMYMEADOR CONTRACTORSMEADOR CONTRACTORSMEADS, PAUL DEANMEDINA, RICHARD D.MEDLIN, JAMESMEDLIN, TERRYMEEK I CMEEKS FRANCESMEEKS, HERMAN F.MEEKS, J. W.MEEKS, LAMARMEEKS, TERRY W.MEHAL, KAREN ANNMELVIN ATLANTIC SERVICEMELVIN JOHNIEMELVIN JOHNNYMELVIN, ELLEN J.MELVIN, ELLEN J.MELVIN, JOHNNIEMENDENHAL J LMENDENHALL CHILDRENMENDEZ, ROSALINAMENDOYA, SAMUELMENSHON, RICHARD T.MENSHON, RICHARD T.MERCER MAGGIE MAEMERCER WILLIEMERCER WILLIE LEROYMERCER, FREDDIEMERCER, HARVEYMERCER, LARRYMERCER, THEMUELMERIDY CURTISMERRILL WILL HMERRIMAN HOWARDMESORIO LORI & RUDYMESSER, KENNETH L.MESSERLY, ROGER THOMASMESSEX CELIAMETAL SPECIAL TIRESMETLOW, ANNIEMETTS, J. H.METTS, RUBY D.MEYEROWITZ, ROBERTMEYLOR, THOMASMICKEL, CAREY A. IIIMICKLER, P. R.MIDDLETON, ROBERT V.MIDDLETON, ROBERT V.MIKE'S PACKAGE SHOPMIKELL BILLYMIKELL BILLY - FARMMIKELL FLOYDMIKELL JIMMIE LEEMIKELL JIMMIE LEE & PATRICIA AMIKELL LOREN LMIKELL RUBINMIKELL TERRY & DOROTHYMIKELL, BOBBYMIKELL, BOBBY LEEMIKELL, CHARLESMIKELL, EUGENE JR.MIKELL, EUGENE, JR.MIKELL, EUGENE, SR.MIKELL, JOHN S.MIKELL, MRS. A. B.MIKELL, MRS. EMMA S.MIKELL, ROSEMIKELL, SONJAMIKELL, WILLIAM C.MILBERG, JOSEPH B.MILBRATH, BRIANMILES JEROLENEMILES, FRANKLIN D.MILES, JAMES L.MILES, MIKE REV.MILES, WENDELLMILLEN RONNIEMILLER BERNICEMILLER BETTYMILLER BUIEMILLER BUSTERMILLER E WMILLER GINGER MMILLER HUBERT GMILLER HUBERT JRMILLER J HMILLER J RMILLER TONY LMILLER, AGNESMILLER, BILLY R.MILLER, BUIEMILLER, CARLMILLER, CHARLESMILLER, CHARLESMILLER, CLAUDEMILLER, DAVID C.MILLER, DENNISMILLER, DOCKMILLER, DOCKMILLER, DR. CLIFFORDMILLER, EARNEST W.MILLER, F. P.MILLER, GEORGE H.MILLER, GLENNMILLER, HAROLDMILLER, HARVEYMILLER, J. I.MILLER, JOANNAMILLER, JOANNAMILLER, LAURA C.MILLER, MIKEMILLER, MRS. FREDMILLER, MRS. M. L. SR.MILLER, O. H.MILLER, PAUL G.MILLER, R. P.MILLER, RAYMILLER, ROGER DALEMILLER, ROGER DALEMILLER, T. L.MILLER, TAMMYMILLER, TONYMILLER, TRACY (SHOP)MILLER, W.T.MILLER'S SHOP & SAVE GROCERYMILLS, CATHY S.MILLS, DONMILLS, JOHN C.MILLS, JOHN IVMILLS, PATMILLS, PATMILLS, WILLIAMMILTON, ROBERT E.MILWEE, TOMMIMS GORDON GORDON ROSS & MELIMIMS, H. CLAYTONMINCEY A U STOREMINCEY ALMAMINCEY ATWOODMINCEY CONNIEMINCEY IVORYMINCEY MARYMINCEY ROBERTMINCEY WILLIAM W JRMINCEY, ALMAMINCEY, ALMAMINCEY, AUSTIN M.MINCEY, BUNETTMINCEY, HATTIE M.MINCEY, HELEN AND BOYMINCEY, J. C.MINCEY, JAMES EARLMINCEY, JERRYMINCEY, JERRYMINCEY, JERRYMINCEY, JERRYMINCEY, LISAMINCEY, LISAMINCEY, MELISSAMINCEY, MICHAELMINCEY, MICHAEL & DIANAMINCEY, PAMELAMINCEY, QUEEN ESTERMINCEY, QUEEN MRS.MINCEY, SHALAH D.MINCEY, SONYAMINCEY, VIRGIL D.MINCEY, WILLIAMMINICK GARDEN CENTERMINICK JAYMINICK JEANNEMINICK OBEDMINICK, JEFFMINICK, JEFF MRS.MINICK, MRS. J. L.MINICK, TYREL A.MINNEHAN, RANDYMINORS J WMINORS R JMINYARD, GARYMITCHELL CECIL AMITCHELL WASHMITCHELL, BUDMITCHELL, CINDYMITCHELL, DAVID T.MITCHELL, DEBRA L.MITCHELL, EUGENE A.MITCHELL, LEVIMITCHELL, REV. R. ESTUSMITCHELL, ROBERTMITCHELL, V. L.MITCHELL, WILLIAM C.MITCHUM NANCYMIXON BROTHERS HARVESTINGMIXON DENVERMIXON JMIXON KATHIEMIXON, BILLYMIXON, CYNTHIAMIXON, GEORGEMIXON, GEORGE E. , JR.MIXON, GEORGE E. JR.MIXON, HOLLY HENDLEYMIXON, JERRYMIXON, L. C.MIXON, LARRYMIXON, NANCYMIXON, REBAMIXON, W. D.MIZE, VINCENT D.MOBILE HOME MOVERSMOBLEY DENNIS & SUZANNEMOBLEY LINDAMOBLEY M L REVMOBLEY WALTERMOBLEY, C. L.MOBLEY, C. L.MOBLEY, F. A.MOBLEY, F.A. (MICKEY)MOBLEY, FRANCESMOBLEY, P. W.MOCK ANGELINA WHALEYMOCK JOEYMOCK MATTIE TMOCK RANDALL - COMPUTERMOCK ROBERTMOCK, BILLY R.MOCK, BILLY R.MOCK, CHARLES F.MOCK, DOUGLASMOCK, EVELYN MIXONMOCK, J. R.MOCK, J.L.MOCK, L MALCOLMMOCK, MALCOLM L.MOCK, P.A.MOCK, P.A.MOCK, P.A.MOCK, RANDALLMOCK, RANDALLMOCK, REX A.MOCK, SAMMOCK, SHERRYMOELLER, MARGARETMOFFETT, HOLLISMONETTI AND COMPANYMONGIN, JAMESMONS, P. R.MOODY GARY W. SR.MOODY, JAMES C.MOODY, OSCARMOON JOHN RMOON RANDALLMOON, BOB JR.MOON, BOB, JR.MOON, DONALD B.MOON, W. M.MOORE & ASSOCIATESMOORE BENMOORE ELLA MMOORE HIRAMMOORE JOHNMOORE JOHN LMOORE JOSELLEMOORE LONIEMOORE SPENCER JRMOORE TAMMY J.MOORE WILLIAM HMOORE, CORVINMOORE, CRAIGMOORE, DANIEL A.MOORE, DAVIDMOORE, DENNIS F.MOORE, DENNIS F., JR.MOORE, DEWITTEMOORE, EDWARDMOORE, EVA J.MOORE, FARREN F.MOORE, FRANKIEMOORE, HARRYMOORE, J. P.MOORE, J. T.MOORE, JEANETTEMOORE, JOEMOORE, JOSELLMOORE, JOSELLEMOORE, KERRYMOORE, LETHA ANNMOORE, LONIEMOORE, LOUISMOORE, MARIONMOORE, MARK A.MOORE, MARK E.MOORE, MICHAELMOORE, MRS. LILLIAN A.MOORE, PAULMOORE, REGINALD J.MOORE, SANDYMOORE, SKEEBOMOORE, TIMOTHY J.MOORE, W. H.MOORE, WILMATINEMOORE'S PAVEMENT MARKINGSMOORER MASON (FAX)MOOS, WILLIAM H.MOOT KOUNTRY KITCHENMORAN, ATINAMORGAN BRENDA F.MORGAN DIANNEMORGAN DR RELAND & BARBARA LMORGAN REID BMORGAN RHONDA EMORGAN VERNON LMORGAN WARRENMORGAN, BOBMORGAN, DAVIDMORGAN, GERALDMORGAN, GERALD D.MORGAN, GERALD D.MORGAN, GERALD D.MORGAN, GERALD G.MORGAN, MARKMORGAN, MICHAEL S.MORGAN, MIKEMORGAN, ROSE M.MORGAN, WARRENMORGAN'S UNION 76MORRIS ALEX LMORRIS ANNMORRIS BANKMORRIS BANKMORRIS BANKMORRIS BANKMORRIS BANKMORRIS BANKMORRIS BANKMORRIS BANKMORRIS BANKMORRIS BANKMORRIS BANKMORRIS BANKMORRIS BANKMORRIS BANKMORRIS BANKMORRIS BANKMORRIS BARBARA SMORRIS CABINET SHOPMORRIS CHARLES SMORRIS CLAYTONMORRIS DARRELLMORRIS DONNIEMORRIS ELECTRIC MOTOR SERVICEMORRIS HEIDIMORRIS JOHN T.MORRIS MILDRED JMORRIS MINIT MARTMORRIS MONTE CMORRIS T J COMPANYMORRIS ULDINE MMORRIS VILASMORRIS W HARMONMORRIS WENDELLMORRIS WENDELLMORRIS, ALICE A.MORRIS, ALICE F.MORRIS, ALLEN J.MORRIS, BARBARA C.MORRIS, BETTY LYNNMORRIS, CINDY N.MORRIS, CLAYTONMORRIS, DELMAS R.MORRIS, EMMAMORRIS, FRANKLINMORRIS, FRANKLIN E.MORRIS, J. L.MORRIS, JAMES E.MORRIS, JERRYMORRIS, JERRYMORRIS, JERRYMORRIS, JOHN D.MORRIS, JULIE L.MORRIS, KAYE T.MORRIS, KENNETH D.MORRIS, LOUISE W.MORRIS, MARY ANNMORRIS, MERLEMORRIS, MRS. BETTYMORRIS, MRS. HOWARDMORRIS, MRS. WENDELLMORRIS, RAYMONDMORRIS, ROBERT C, DR.&MRS.MORRIS, RONMORRIS, SILASMORRIS, T. J. (PAGER)MORRIS, THOMAS C.MORRIS, THOMAS C.MORRIS, V. B. MRS.MORRIS, W. G.MORRIS, W. J.MORRIS, WENDELL F.MORRIS, WESLEYMORRIS, WILLIAM H.MORRISON, ALBERT H., JR.MORRISON, TONYAMORROW ALVINMORTON B HMORTON B. H.MORTON, B.H.MORTON, J. W.MORTON, RANDYMORTON, RANDY L.MOSCRIP, ANDYMOSELEY CLEM CMOSELEY LILLIE PEARLMOSER, RONALD W.MOSES, TRIPMOSES, WARREN P.MOSES, WARREN P.MOSLEY CARRIE MAEMOSLEY CHARLES & LOUISEMOSLEY LINDAMOSLEY W.C.MOSLEY, BOBBYMOSS, S. L.MOTES JOHNNYMOTES ROBERT J.MOTES SERVICE STATIONMOTES, ELLYMOTES, GERALDMOTES, GERALDMOTES, GERALD (MOBILE)MOTES, JOHNNIE E.MOTES, JOHNNYMOTES, JOHNNYMOTES, JOHNNYMOTES, PATSYMOTES, SUSANMOTES, TEXACO SER. STA.MOTOROLA COMM & ELEC, INC.MOTOROLA COMM. & ELECT. INC.MOTOROLA COMM. & ELECT. INC.MOTOROLA D I D TRUNKMOUCHET, RHETTMOXLEY ANNIE SULAMOXLEY MRS JAKE (ANNIE L)MOXLEY, CLARENCEMOXLEY, JAMESMR. LEE'SMR. LEE'S PAY STATIONMR. LEE'S PAY STATIONMRS. J. FELTON LANIERMT OLIVE MISS BAPT CHURCHMULL, FRED W.MULLEN SANDRA EMULLINS, PAULMULLINS, THOMAS G.MULLIS, KENNETH DALEMULLIS, PARKER N. JR.MULLIS, WILLIAM D.MURPHEY, DONNAMURPHY, DAVEMURPHY, DAVE W.MURPHY, DENNISMURPHY, M. L.MURPHY, R. W. V. JR.MURPHY, RONALDMURRAY BILLMURRAY GLORIAMURRAY JAMESMURRAY MAEBELLMURRAY MARY AMURRAY WAYNEMURRAY WYNELLE MMURRAY, DERICKMURRAY, ETHEL MAEMURRAY, MRS. B. B.MURRAY, WILLIEMURRAY, WILLIE B.MYERS W LMYERS, J. A.MYERS, LILLA A.MYERS, LYLEMYERS, MICHAEL D.MYRICK SALLYBULLOCH 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: 50 MB.Is there anything else you'd like to tell us?
