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Home My WebLink Aboutnewletter 2002 springeh" r • � Nast !II \' � =\ Enfield Community Currents Spring 2002 FREE Community Contacts The Town Board: Jean Owens, Town Supervisor 273-5682 Greg Stevenson, Deputy Sprvsr. 273-2439 Ron Switzer, Counciperson 256-2764 Mark Roach, Councilperson 2734362 Pat Gumaer, Councilperson 272-5245 Town Officials: Alice Lane, Town Clerk 272-1690 Diann McFall, Deputy Town Clerk 272-7993 Jane Murphy, Justice 277-1774 i Betty Poole, Justice 272-M David Miller, Hwy. Superintendent 387-9080 Ron McFall, Dep. Hwy. Super. 272-7993 ! Sue Thompson, Town Historian 272-6412 Enfield Community Council: ' Rob Ainslie, President 273-2258 . David Albrecht, Vice President 387-9340 Carol Givin, Treasurer 273-7434 { Vera Howe -Strait, Secretary 273-1413 ti Kim Albrecht, Currents Editor 387-9340 - - - Town Phone Numbers: Town Hall 273-06 Highway Department 272-6490 Town Court 273-0363 0 Town of Enfield... Watch your mail carefully for the next few weeks. You will be recehing information and details concerning the following: Town -wide Trash Clean-up Week, May 6-11 Entield Community Garage Sales, May 17.19 Farmer's Market Town of Enfield Website Enfield Treasure Hunt New in Currents... You will notice a new addition to the Enfield Community Currents. A Community Calendar, which we hope will be useful to people, will now be included in each edition. If you have suggestions or dates for August through the end of the year, please telephone or e-mail Ann Rider at 277-3478, arider@tompkins-co.org, so they can be included in upcoming editions. The community council is also sponsoring an Enfield a -mail address directory. this would help us be in touch with each other. If you would like to include you e-mail address in this directory, e-mail Ann Rider at the address above. The Enfield Valley Grange Would like to thank those family and community members who Made donations ut memory of Bob Linton andDeAa Snyder Thev are mined and remain in air hears and memories. Page 1 Around Town Senior News n LJ 0 Enfield Food Distribution The food distribution has been in existence for over 20 years. Presently the pantry is manned by approximately 20 volun- teers. Over 25% of the population of the Town of Enfield access the pantry at least once a year. fast year we distrib- uted over 300,000 pounds of food. Our mission is to elimi- nate hunger in Enfield. The pantry is open April 2,14, and 30, May 14 and 28 from 2:30 to 6:30 p.m. Bring a utility bill for proof of address. TOPS Market donates their day old produce and baked goods to us. Those distributions are on April 4,11, and 25, May 2, 9, 23, and 30 from12:00 to 12:30. Our pantry is a member agency of the Food Bank of the Southern Tier in good standing and a member of the Tompkins County Food Distribution Network. H you know of Tompkins County residents in need, go to http:/ / tompkinsfood.org/ for referral information. Enfield Valley GrangePlantExchange 10:00 to 12:00 Community Building Do you have too much lemon balm or lambs ears? House plants sending off shoots and babies? Come to the plant exchange; bring your extra plants, And pick up some new varieties. For info call jj @ 277-1774 Tiiplejhomestead @ peoplepccom Senior Citizens... H you have any concerns about health matters, nursing homes, transportation, or anything else that you would like to have the County Office For the Aging (COFA) know about, Please contact Roy Wollney at 273-5075. As a member of the COFA Advisory Committee, representing Enfield, (and others), he will see that your concerns are brought to the attention of COFA. Enfield Valley Grange Many of you may pass by the Grange Hall located between the community building and the Baptist Church and wonder, "What is the Grange?' The Grange is comprised of families and individuals that share a common interest in community involvement, agriculture, and rural issues. since the organization's original inception in 1867, people from all walks of life have been attracted to the Grange. The fraternal aspects foster a deep sense of belonging. The mission is simple; to improve the quality of farm and rural life through community service, legislative activities, and leadership. The goal of grange advocacy is the well being and prosperity of rural America. The Enfield Valley Grange was established in 1875. Prior to owning a budding, grange meetings were held in Wortman's Hall, Enfield Center. Rent for the hall was fifty cents, and that included janitorial services. When the hall was no longer available the Grange built their own building. On August 24,1926 dedication ceremonies for the new grange budding were held, approximately 600 people were in attendance. Currently the Enfield Grange is the only Grange Hall still in operation in Tompkins County. In order to keep this building as a community resource, repairs and renova- tions need to be done. The current grange members re -sided the building last year and are hoping to replace the roof this summer. You can easily become a part of this organization, we need Paget • LJ and welcome new members. We meet the third Wednesday of every month at 7:00 p.m. in the Grange Hall. Some of our upcoming events include: Pancake Breakfast, Saturday April 6m Pancake Breakfast, Saturday May 4m Plant Exchange, Saturday May 4° Pancake Breakfast, Saturday June V Youth News Enfield Youth program Fmm Shannon McSurely, Teen Program Manager Greetings from the Shining Enfield Youth Program! All programs are free with limited space (registration required) for residents in 6th -12th grade. Want to know what's happening? Contact me to add your name to our mailing list if your family would like to receive the monthly calendar of specific goings-on for regular Monday programs, Thursday Outings, Saturday Community Projects and Enrichment Trips. (If you are receiving the mailing and you don't want to, please let me know that, too.) Monday Makers learn craft skills with market potential at the Enfield Community Building (182 Enfield Main Rd.) on Mondays from 3:30-6:00 p.m. If you go to Dewitt Middle School, you can get a bus pass for bus 10, to be dropped off at the building. If you go to ACS or you are home -schooled and trying to figure out how to come to a program, call me! High Schoolers, you can get community service hours by helping me with my programs! ARE YOUR KIDS MAKING YOU CLIMB THE WALL? Why not get them to climb it with you? I am planning a Saturday Community Trip to the Lmseth Climbing Wall at Cornell this spring (date to be announced). This is great fun for the whole family and a wonderful opportunity to get to know your neighbors, learn climbing skills, and try rock climbing! There will be a minimal fee $3/child, $5 adult and a family maximum of $15. No one will be fumed away due to an inability to pay. It is a pleasure to serve my community and I look forward to future programs with you all. Shannon McSurely 272-2292 x229 Enfield School Age program From Vera HowrShait, Duwtor Spring is here?? We sure hope so because we are ready for lots of outdoor time at the program. The school age students have been busy this year writing many different types of letters (thank-you's for a special favor or for who you are, holiday greetings or a joke to put a smile on your face) to friends, teachers, relatives and patients at the Cayuga Medical Center. The students have participated in several enrichment classes offered. A group of girls taking gymnastics and ballet/tap classes, with Lucille McGill, just recently performed at Lakeside Nursing Home. They all did a wonderful job and put smiles on some faces! Some students just finished a "mind stretch" enrichment class offered by Judy Blood (4th grade teacher at Enfield). They all had fun and " work those brain muscles, including me (and 1 wasn't always successful at solving the puzzle!) Other groups of students are now participating in a cooking club offered by Ann Rider, our community volunteer. It's Page Historian's Scrapbook • 4", • 0 always nice to have a good cook ready and willing to teach US. It does seem early to think about the next school year, but it comes quickly enough. If you are interested in registering your chfld(ren) into the school age program, you may start the registration process now. A goal for next year is to offer many more enrichment classes. On June 8th, the school age program will have a garage sale in the school parking lot. All proceeds will go to the program to assist in the start-up for the new school year (supplies, equipment, insurance, etc.). All parents and community members who would like to donate "garage sale items" for this event, please drop off items at the school that morning (8:00-9:00) or to the program during the week before the sale. As usual any donations (games, books, craft supplies, recycled paper) during the school year are gratefully accepted. Lastly, and I know prematurely, I would like to thank my staff for their involvement in the program this year. Reid Waring and Tom Corwin have been with the program for 3 years and are moving on in their careers and lives. Many thanks and good luck go to them; the students will miss them. Marge Lener and Julie Jordan will return and lucky for me! Marge runs our very successful book program. All the children benefit from the books they receive monthly. Julie has been a positive influence on the younger children and shares the interest and talent in sewing/crafts that the older students have. Of course I would like to thank all the parents for their support and especially the parent board for their support and confidence in me to direct their children's program. And the students, well, they have been a pleasure, as children are, and definitely filled the program with chal- lenges, fun and lots of laughter! From Sue Thompson, Enfield Town Historian Family History requests have been received from the following families: Burlew: William Burlew born 1756 son Millen whose son was Oliver bom to Millen Burlew and Betsy Updyke in Enfield about 1833 or 1835. Sheffield: Jonathan Sheffield believed to be bom in Enfield (Ulysses), 22 April 1755 and died Oct. 18,1812 and his wife Olive (Bowers?) believed to bom in the same town Dec. 10,1759 and died Nov. 26, 1834. Christian: information requested,on whether the family existed, of the Christian Hill Area of Enfield, or anv information on the area. Roloson (Rolison) Family Robinson: Daniel and Amanda married 1825-1826 Arial Martin Lawton: sixth pastor of the Enfield Baptist Church. Peter Head Familv and Elizabeth Odell If you can help with these family history questions, please give me a call (272-6412) or send me an e-mail (sdtl@comeB.edu). Thanks. On June 1, I will be helping to Host a 2002 APHNYS (Association of Public Historians of New York State) District 10 Meeting in Trumansburg at the Ulysses Historical Society. As Town Historian, I am a member of this organization, which involves all county and town historians from, Broome, Chenango, Chemung, Schuyler, Tioga, and Tompkins counties. On a recent trip to the Tompkins County Clerk's Office, I had the delight of visiting a book called, "The Mortgage Book". 1 was looking for references to the Woodward family and these are a few of names I came across, starting in 1832 and going to 1836: Woodwards: Elizabeth, Elijah.R., Charles, John, Henry F., Thomas Henry, Samuel, William Amos, and Benjamin. Other names were: Seth Leonard, Amos Ogden, Reuben Lyon, Richard Smith, George Wickham, Elizabeth Grant, Simeon Dewitt, Joel Basset, Walker Jacob, Tunothv Williams, and Ephraim Mead. Page4 Town Court Topics • Where's the Money? by farce Murphy and Carolyn ILall Another question people frequently wonder about Town Court is what happens to the fine money and court fees that are collected by the Town Court. All the money is turned into the state and the state then remits certain money back to the Town. It is also possible for the Town to do the appor- tioning calculations and keep the Town portion and send the state its portion All civil fees collected by the Town Court come back to the Town Civil fees are mostly fees charged to bring an eviction or small claims case to the court. Civil fees returnable to the Town also include some civil fees assessed by the court, such as in animal control cases (failure to license dog) but do not include other civil fees (like civil environmental conservation law fees, but these are not typically seen in Enfield). Ail drink driving fines go to the county to fund antidnurk driving programs. The mandatory surcharge (charge assessed in addition to the fine) on drunk driving cases goes to the state. All Town Ordinance fines are kept by the Town, there is no surcharge to go to the State. Also, all Agriculture and Markets fines are kept by the Town (animals running loose, failure to license dog) and there also is no surcharge to go to the State. Speeding fines do not come to the Town The Town gets a set fee of $15 per speeding case from the state for handling the case. The mandatory surcharge (charge assessed in addition to the fine) on speeding cases is generally$35 per case. Most equipment violations fines do not come to the Town (inadequate muffler, lights, bad tees, etc.) The Town gets a set fee of $15 per equipment violation case from the state for handling the case. There is also a mandatory surcharge (charge assessed in addition to the fine) that must be paid by the motorist. Unlicensed operator and aggravated unlicensed operator (driving with a suspended license) fines also do not come to the Town. The Town gets a set fee of $15 per unlicensed operator case from the state for handling the case. There is also a mandatory surcharge (charge assessed in addition to the fine) that must be paid by the motorist. Vehicle and Traffic law section 1100 and 1200 are the other main traffic offenses seen in Town Court. These mostly are disobeying a traffic control device, bad passing, bad signal- ing, bad parking. The Town gets all the fine money on most VTL section 1100 and 1200. On offenses and crimes charged under the Penal Law, the Town does keep all fine money. However, it is fair to say that many catagories penal law crimes (theft, assault, harass- ment, etc.) are often punishable by jail or probation rather than Fines. T here is also a mandatory surcharge on penal law charges that, if collectable, goes to the State. When there is bail, and a conviction results, the court assesses a 3% fee on the bail. 20% of the bail amount comes back to the Town. 1% goes to the County to fund alternatives to incarceration programs. Pages This newsletter is published 3 times per year. April, August, and Decem- ber. The deadline for contributions is the first day of the publication month and should be mailed to the editor, Kim Albrecht, at PO Box 214, Jacksonville, NY 14854 prior to this date. This publication welcomes contributions from all Enfield town residents regarding events and services available to Enfield town residents. All Err field Community Council programming, mclud- ing this newsletter, is made possible in part through funding by the United Way of Tompkins County. V Enfield Area Businesses .x A Touch of Country B&B Howard and Joyce Dixson • 119 Enfield Main Road Ithaca, NY 14850 272-9435 • 0 Agate Lamp Therapeutic Massage Marla Perkins, MA, IMF 273 Black Oak Road 273-5664 agatelamp@yahoo.com Applegate Bed & Breakfast Sherry Ann Conlin and Tim Odell, .... - Proprietors ' 272 North Applegate Road 272-6519 Applegate Tree Farm Phil and Mary White 348 South Applegate Road 273-3155 CCB, Inc. Brenda Watkins, Manager Construction and Property Man- agement Enfield Main Road, PO Box 547 277-0332 Cascadilla Tree Care John Friedeborn and Karen Anderson 877 Bostwick Road -- 272-5447 Dares Fuel Service, Inc. Fuel Oil, Kerosene, Gasoline, Diesel 2102 Mecklenburg Road 272-0679 Dougherty Outdoor Care Snow Plowing & Lawn Mowing William Dougherty, Jr. 166 Enfield Main Road 272-0877 Enfield Auto Used Cars Owners Don & Carolyn Monroe 386 Enfield Main Road 273-8919 or 272-5733 ET Discount Railroad Ties Earl Tuttle 216 Ehnira Road 277-7444 Facial Enhancements Brenda Watkins Enfield Main Road, PO Box 547 256-0364 ivww.cnygifts.com/faciaI.htru H&H Auto Sales Ken and Randy Hoover 644 Enfield Falls Road 277-5253 Hillendale Golf Course 218 North Applegate Road 273-2363 Johnny's Wholesale, Inc. John Nino 56 South Applegate Road 272-6261 Kimberly's Daycare 166 Enfield Main Road 272-0877 Email- KielyJai@cs.com Lambchop Hill Ceramics Jim and Mary Linton 19 Shudaben Road 277-3998 Page Night Owl Construction Stephen L. Givin 139 East Enfield Center Road 273-7434 sgivtn@ntmcom Pellegrino's Saab Service Nicholas Pellegrino 2282 Enfield Main Road 272-8259 Plumbing & Heating Repair Jack Kulp 228 South Applegate Road 273-2632 Rainbow Sewing Lessons Specializing in kids ages 7 & up Theresa Robinson, Owner/ Instructor 570 Bostwick Road #157 Ithaca, NY 14850 275-3298 Sandy Creek Manufactured Housing The Vandemarks 2068 Mecklenburg Road Ithaca, NY 14850 273-1623 or 273-6855 Fax 277-5066 Shadetree Auto John Grady 1047 Teeter Road 277-5959 Valley Komers Grocers Dan and Diane Achilles 2102 Mecklenburg Road 273-6015 �:1;'tClfi4E'i'! i�!f :tl: i •1 `ei: �. w ��►�r. �C .i"I►i`I�j L�.1 � a��JJ.� f ' Utll ll�7�� •MIIN Pf (l �`Ytli .�ISII: \ l .._ Fr,Yll��:< i17� _tll ids:, � � � y-,�iq,•, (.o�llur Join us in the early evening with your lawn chairs and blankets for Family Music • Town Courts sun III. Tu• W.a ' 2 Thu $d s rar Judge Murphevery Tus- •. 26ea° c°'..",Y. tPav II Ie),awo--wv..l I7� day from 10-12 AM M,.",biOio°' I �^"'""'• . Judge Poole- every Monday ) a v w u .1 U 5PM 7-W ).w.} n • Judge Poole— Ikuun$ �+ °�^ thejudge@lightliuk.com •Judge Murphy_ rs is ir_r.. o.... I x+..e r•.,T In 11.aos.u,. re w m triplejhom,stead@peopt )7-W. It.ae.�. . w• .�.•.• )-u�. !I com S C H O O L B R E A K _ 11 xx 11 N ixe xe xx Senior Citizems _ • Meets at the Grange. Bring - your own table service and 38 30 dish to pass. Call Roy I :rarusl 2 I� - — Woolney, 273-5075 for M.nv more info Enfield Community Calendar `J A busy month • Dice Run + Country Fair The 5ih Grade is having a dit%rent event this year. They are having a Dice Run + Country Fair. This is a 100 mi. motorcycle road rally. Call Jane Conroy at 274- 6838 for more information. Join the fun and support our youth!! • Plant exchange 10 AM -12 on May 4 at the Community Bldg. Call Janice at 277-1774 • Community Yard Sale May 17-19. Call Jean at 273-5682 Sun M.. Tue W.a Th. Erl sun ' 1 4ao-"A �G`rm�'r•'y�� )ao-M erMrs ppe Ga•ivl sa,o�n ro-nn. •w s e a v ro rl -War�Y MhnNml 6N4Twn M0b1 w..M1p ..na u u IA Is 11 fx re exc Ww YARD SA. E WEEK- ..____.._. _. _ _. .. iv m n 71 22 :,1 xs w oor END rwinAr 2e a 2e so n — saroor 2.r.n I— aaoAY Enfield Community Calendar • School's Out!!! • 5th Gnde Gnduarion May 18 at 6:30 at Ole En- field Elementary Gynaussium $.a Mew To. Wd Tau Fri ] ] 1 6 2 9 t0 1111.WdN' 12 13 la 6rta yKL Sb]Oiwd 6r30-T rawnra loom 62Psia We 11.303 a.nden•. O1°'O 5th Gmde trip 1 G.aee ]] 2425 26 ]) ]e V (Mr Cf ],ijo. lobate ronoy c aMe 20 Enfield Community Calendar Sun Mon Tv• Wa Thu Fri W • Enfield Churches d 1 2 2 e 5 9-2 S—, eMr9•Mra°• • AgaBask ehureh pe curare• Oar 264 S. Applepte Rd. IBIae;NY 16850 2 • 9 10 11 12 12 273-7419 2-W—% 2-11h d d.10-T— 740-Fw 0p SuMay sa<vices- MWhM,, Fa+'a a.a.d aeelb 830 AM 9:45 AM includes nu rsay, C6iM1en's 16 1s n Ile 1cn�au. Ia 19 2a church, bi-monthly youth ministry, adult 6-8.30 EFFC Vocatlon 2'C^a"Fr e•^' B I b I a 5 c b e e I teaching and payer mmisey ea 21 22 22 ]e 25 2e 2J • Flrst Bap1W Church of Enneld 24.30 .p Ile Wield Main Rd. ra.r 2774301 Pillar Jack Gsbom-387-9001 2a 29 20 21 sindby services- 9 AM -Bible study 10 AM -Worship Includes QllMRnY church and nursery. The church is SRun. spring Vacation Bible School July 15-19 from 6-8 30 each evening. The theme this year is "Cruising the Amazing AnezOn" Enfield Community Calendar 91 d Enfield Summer Day Camp w 2002 • Dates: Monday, July 1-Friday, August 9th (No camp on Thursday, July 4th) Time: 9 am.-2 pxi Ages: 4 -13. There is a counselor in training program for 13 - 15 year olds. BmaidastlLunch: Provided free of charge by the Tompkins County EOC Program. Campers can also bring their own lunch. Cost for six weeks of camp: I child - $80.00; Second child - $40.00; more than two children - S150.00 total. All fees must be sent with registration. Before Camp Day Care: 7:30 a.m. - 9:00 a.m. 1 child - $2.50 per dayf$75.00 for six weeks extra children - $1.50 per dayl$45.00 for six weeks per child _ — *****All children who will be attending before camp MUST be signed up the previous week. There w1B be no more day -today drop -ins because we are unable to coordinate the staffing- ***** What Should Your Child Bring to Camp? Campers should bring a swimsuit, towel, and shoes that are appropriate for sports and walks in the woods. They also need a filled plastic water bottle. It is also a good idea to send an extra change of clothes for the younger children. We are not responsible for lost or stolen items. Please do not send electronic devices such as walkmen, gameboys, etc. Questions???? Call Vera Howe -Strait 274-2368 or email: Vstraitl8@cs.com Please make checks payable to ECC. Completed applications and fees should be returned to Enfield Elementary School or mailed to: Enfield C6miuwuit3' Ceanell Sommer Day Camp P.O. Box 214 • Jacksonville, NY 14854 DIPORTANTIII INMRTANTII! IWORTANTII! IMPORTANT!!! Camp applications are accepted on a first come, first serve basis for Enfield residents. Only complete applications which include payment and the Summer Food Service Program Financial Information Sheet will be accepted. The information on this sheet is confidential and is seat to the Tompkins County EOC Program. The only parts that need to be completed are Items 1, 2, and 3. It is okay to write "not eligible" if your child does not receive free or reduced lunch at school. This information is gathered for the camp as a whole. All children will be given breakfast and lunch regardless of the information on the form. Ifyou currently receive temporary assistance through DSS you may be eligible for assistance for the Summer Day Camp. If you are a working parent(s), and your income falls under the DSS low income qualifications guidelines, you may be eligible for Summer Day Camp assistance. Please call or email Vera for information. w. P CI 0 Enfield Community Council Summer Day Camp Application Child's Name Birthdate Age_ Grade Completed_ Address Enfield resident? yes no Parents/Guardians Relation to camper Home Phone Work Phone Emergency Contacts (If parents are unavailable) in case of illness or injury: Name Relation Home# Work# 2. _ List those authorized to pick up this child: Name Relation Home# Work# n _ List anyone not authorized to pick up this child: Name _ Relation As required by the Tompkins County Health Department, we cannot accept applications without the last dates of the following immunizations: DPT_ Tetanus_ Polio_ Measles_ Mumps_ Rubella Medical Information Concems we should know about Allergies List Medications (asthma, seizures, bee stings, diabetes, etc.) Family Physician Phone# My child is allowed to swim: yes no My child has permission to go on field trips: yes no I hereby give my child permisseon to participate in the Enfield Community Council Summer Camp program. I understand hat the ECC is not responsible for any accidents or injuries unless there is negligence on heir part. Parent/Guardian Date _My child will be using beftire camp care during the first week of camp.(extra cost) _My child will be using after camp care during the first week of camp.(extra cost) _My child will only be at camp between 9:00 a.m. and 2:00 p.m. the first week of camp. s. r.. i.r, .a... tmchmcnt A-3 • • • ELIGIBILITY FORM FOR CAMPS AND ENROLLED SITES INSTRUCTIONS ease compkre the Summer Food Service Program Eligibility Form for Camps and Enrolled Sites using the insmucdoas below: gn the farm and return it to the sponsoring mvxnf+vrvnn. Call the sponsor if you need help: Y %RT 1 - PARTICIPANTS INFORMATION: All HOUSEHOLDS COMPLETE THIS PART. ) Punt the uro of your own household's child. , \R'T 2A - HOUSEHOLDS GETTING FOOD STAMPS OR FOOD DISTRIBUTION PROGRAM ON INDIAN _ ESERVATIONS C-DPIR) OR TEMPORARY ASSLSTANCE TO NEEDY FAMn ri•'.¢ (TANF) BENEFTTS: COMPLETE ilS PART and PART 3. - ) Lin your current food sump case cumber or your FDPIR or TANF idmti5ration tuba for the pa ' -Tint Do not compl, n 2B. ) An adult household member tout sign the statement in PART 3. iRT 2B - ALL OTHER HOUSEHOLDS: COMPLETE THIS PART and PART 3. i Wme the nam's of everyone in your household. I Write the amount of income rcccved last month for each household member. Ibis mr-0me is the amount before tones or anything e is tat, o= and where it came from. such as earrings. welfare, pensions, and other income (refer to esampks below for types income to report). If any amount last month was more or less than usual• write that pc=a's usual income. . An adult household amber curer sign and give his/her social security muo in PART 3. . _ ST 2C - FOSTER =- COMPLETE THIS PART and PART 3. Write the fosses child's monthly *personal use' income. Write -0' is the foster child does of get'personal use' income. A foster parent or other official reprMcndog the child most sign the form HT 3 - SIGNATURE AND SOCIAL SLCURTTY NUMBER: ALL HOUSEHOLDS comn lB THIS PART. All eligibility forms most have the -go, nae of an adult household member. - - The adult household member who sagas the m...n.n, must include his/her social security number. If belshe does out n a social setmrhy cumber. write 'none' or something else to show that he/she doe not have asocial security amber.. w listed a food ssa, FDPQ2 or TANF idend5carion member, a social security number is of needed. RT 4 - RACLIL/ETEMC IDENTITY: COMPLETE THE RACfALJE]iD11C wLv n 1 i r t1w1 MON IF YOU WISH. You not required to answer this question to get meal beae5ts. However. this information wtu help canoe tbm everyone is treated INCOMETOREPORT fioo�avment W.tqc 'lots frnRnilemr!r/S a-ial f-amry Pe�asppa�s ONcj �f� fr77tpinvmrye Disaniluy beoefis _ ,.e i . Suppj m l Sc�uy I� Cash wimchawn from savings a pmymem mmpcasatwo s sa.:' Raisemem inramc lmaet/dividends ter s mmpmn000 .rx .x .:.: Veteran's paymoas __ . '- .- ; ....:.::... _ Iocame from esntesltmszsl raceme berm scifowned "*Ana a Social sc m rue a(T kvcs m= 1SIffi or ban 'C e'.ne -. ...,.Ar.,v ,Or .Watley so rep Regular Contributions from S^. ftaW '+ : .. • . - :`e ii 4bmq t aatt-ID :J aana: • persons not living in the SrrJOdld SuppoNAlimow household is %town¢ payments :.'. tcuNtpt x 49 of 14W tat:• mNla aadT .nr..tm vww i'a 4... Net myaluer/ammnsees/ . ire payments = r®I income coy/childsupport paymcntt xrot Wt xn a' HC 5 .a w a ftm .K IMAM Any other income 4+1 .: X Ii �t;, a,; h 3:.8x%'i ,. S'F.' 'i'�''Yai:Vd ,tL � y •: ;`L3:;. ,y,,,•>#itsl •:.till . ri :AW Y•z�ascl . - tit • w 0 ovivalvar.KPU(jL) b> xvii,r; rxvLi`1VUvl ELIGIBILITY FORM FOR CAMPS AND ENROLLED - PART 1 Child's Name: _ Last Fim M.I. ....... .........:.. _. PART 2A - HOUSEHOLDS NOW GETTING FOOD STAMPS, TANF OR FDPIR B: Complete =_ this part and sign the statement in Part 3 - DO NOT complete Part 2B. Food scamp — u� - FDPM id®Sanao TANF Jdemfeoao umber , PART 2B - ALL OTHER HOUSEHOLDS: If you did not complete Part 2A, complel �p statement inP3TS NAMES CURRFM MONTHLY INCOME N. of HaaNdd Moodily Ea u, from Monthly wdfa — mld Monthly Paym tram Membva (Pati> =' Work olcf ro Daho,) Support Ahm P=—. Re Spaoc. nepmdem Chad=) Job t Soml swzvy 1. S S S y S S. s. S = S 4. S S T, S S 1. S S e this part and sign Monthly rramg from Job 2 W any ooa ldoothly Incranc S t s s s S S S— PART 2C - FOSTER CHILD: Complete this part and sign the statement in Part 3. If this is a foster child check here [ ] and write the child's monthly income here: $ PART 3 - SIGNATURE. An adult household member must sign the statement before it tan be approved. PENALTIES FOR MISREPRESENTATION: I certify tharall of the above information is tore and cmr= and that the food r.amp. FDPIR, or TANF —ba is eorrea or that all income is teponed. I mdastand that this information is beins given for the reccipt of Federal foods: that m union officials may verify the infarmatim m the ^'tat— and that the ticifu = ==C 5mlatiom of [he information may subject me to pmsaution amder applicable State and Federal laws. Sigmature of aduR: Printed mame of adult, Date Si®eo Home telcobone work wintone Social security number. name addr 4P j, J(lr PART 4 - RACIAL/ETHNIC IDENTITY: You are not required to answer this question. ( I whoop m or HupWc origin I I Bbh. Not or Origm f I SaSpats t 1 Assn Or.Padfic 1,11mer f I Amei® lndim or A) - Kzd. Somon 9 of dx N--1 Sdnol Imm Act MTi that, aadea oc W11:4 ool" ford mmp. FDPIR. W TANF umber a pro "d, ym man ioeWd socvl acavl ,Hobe of dx bousebold m®ba siV=g dx — W m iWn dm dx bouxfrold member oipamg the mmmmr doe cot P=— a todil s.=,y comma. PlnYnim of a f0.'d SfflAny -- a Om 0>amaOey. but if a Social 29nRy -- a 6f provided Or an ObOLL n cane Wide ddl f and[ boWrbold m® up ing dx — does oat bane One. die m®r$ omo[ bc appo.ed. TY Wool mnry ,mbc May be Wal to A®fy dx bm d oW toembe in oaTyog an dfua W m* dti ones of mfo t stamd on the mnam. Thee ,Qi(lenm dfuu my b< crtxd our do=9h progm ,eri+s, -Ai Sod m,emgaoom Wd nay mrbede mm®g eorphyeu m d� �, mmmog a food pa . FDP1R a TANF ofrc to deaume omen ruobovov for rexnp[ of hod maga. FDPIR or TANF b=cfi . dx Sun eopioymmx sumiry oRc o demmue dx auouu of beDe W r and the doom p,othed by dx bmoo:hdd mem6a o prove the ananw of mmme rttemd. Tbese dlora nay radt in a k- or rolamon of I fW. id� d—, or kVd amorn if mfaraodon u,cacrad. The So Food Swine Program for Children a an equal opp,=,y pmpam If you bdx,e out you or anyone bat been dma==zd -porn be Of cars. mta. ,mtf®1 Orin sat are. or do-b. -rim vanx-iiny a: Aelrnln:.m,.». Food aw Nonimn Save. US.'DepormeW of Apiodmp 3101 Part r— r . Aleaadru. VA=02. For Sponsor Use Only: Food Stamp/FDPII2j7ANF bousehold categorically eligible free: [ ] Ym [ J No MONTHLY INCOME CONVERSION: WEEKLY X 4.33, EVERY 2 WEEKS X 2.15, TWICE A MONTH X 2 Total monthly income: Family size: Eligible: NOT Eligible: Determining official: Signanirc: Dam: