TEFAP

By signing below, I declare that my income from all sources does not exceed the income listed above for households with the same number of people as my household. I also certify that, as of today, my household lives in the area served by Pennsylvania in The Emergency Food Assistance Program. This certification form is being completed in connection with the receipt of Federal assistance. I understand that these records will be held in confidence at this distribution site but may be released to the Pennsylvania Department of Agriculture or the United States Department of Agriculture for review upon their request.

I UNDERSTAND

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