Address Telephone Number Enclosure: Verification of Food Stamp/Temporary Assistance Recipients Verification of Food Stamp/Temporary Assistance Recipients Adult Member Childs Name Date Range* Food Stamp/ Participated Last Name, First Last Name, First Temporary Yes No Assistance Number *Enter a date range from the month prior to application to the date verification documentation is required. Signature Date Address
Address Telephone Number Enclosure: Verification of Food Stamp/Temporary Assistance Recipients Verification of Food Stamp/Temporary Assistance Recipients Adult Member Last Name, First Childs Name Last Name, First Date Range* Food Stamp/ Temporary Assistance Number Participated Yes No *Enter a date range from the month prior to application to the date verification documentation is required. Signature Date Address
FNSVerificationGuidance2015-16.docx