Food Pantry Distribution Log
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1Food Pantry Distribution Log
Date:______________
Agency Name:____________________________________________________
Client Signature
Firma del cliente
Adults
Children
Seniors
st
First visit since January 1
Name - please print
I hereby verify a need for food. Food is for private use
Adultos
Ninos
Mayores
Primera visita desde ei 1 de enero
and not for sale or barter.
Verifico la necesidad de alimentos. La comida es para uso
Nombre - por favor imprimir
(18-59)
(0-17)
(60+)
Yes Si
# in HH
No
privado y no para la venta o truque.
1
2
3
4
5
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7
8
9
10
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15
We believe that no one should go hungry.
Put Totals Here
Creemos que nadie debe pasar hambre
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Parent category: Miscellaneous