Food Pantry Daily Distribution Log
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1Food Pantry Daily Distribution Log
Date:______________
Agency Name:___________________________________________
Client Signature
Name
Adults
Children
Seniors
First visit this year?
I hereby verify a need for food. Food is for private
(please print)
(18-59)
(0-17)
(60+)
Yes # in HH No
use and not for sale or barter.
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Put Totals Here
We believe that no one should go hungry
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Parent category: Miscellaneous