I certify that:
I. I am:
a. 60 years of age or older; AND
b. My monthly income is at or below the federal income guidelines for my household outlined under 7 CFR Section 249.6(a)(3) of the SFMNP regulations
i. $2,248/month (for a one-person household): OR
ii. $3,041/month (for a two-person household): OR
iii. $3,833/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 understand that I may appeal any decision made by the local agency regarding my eligibility for the SFMNP.
IV. The information I have provided for my eligility determination is correct, to the best of my knowledge. This cerrification form isbeing 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 Federal Law.