I certify that:
I. I am:
a. 60 years of age or older; AND
b. My monthly income is at or beloe the federal income guidelines for my household outlined in SFMNP Policy Memorandum #2020-2
i. $1,968/month (for a one-person household): OR
ii. $2,658/month (for a two-person household): OR
iii. $3,349/month (for a three-person household)
II. I have not received SFMNP checks from any other location this year
III. I have been advised of my rights and obligations under the SFMNP. I certify that the information I have provided for my elgibility determination is correct, to the best of my knowledge. This cerification form is being submitted in connection with the receipt of Federal assistance. Program officials may verify information on this form. I understand that intentionally making a false or misleading statement or intentionally misrepresenting, concealing, or withholding facts may result in paying the State agency, in cash, the value of the food benefits improperly issued to me and may subject me to civil or criminal prosecution under State and Federa Law.