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Get NC DSS-1678 2018-2024

Reason for Report and Replacement Action: I hereby certify under penalty of perjury and/or fraud that food purchased with my Food and Nutrition Services benefits has been destroyed due to a household misfortune. The amount of food purchased with Food and Nutrition Services benefits that was lost in the misfortune is $ . I understand that the maximum replacement amount cannot be more than my Food and Nutrition Services unit’s benefit amount for one month. I hereby certify under penalty of perju.

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Keywords relevant to NC DSS-1678

  • issuance
  • allotment
  • supplements
  • certify
  • households
  • incurred
  • Nutrition
  • Supplement
  • duress
  • intentional
  • AFFIDAVIT
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