HomeMy WebLinkAboutNewsletter 2000 April• ENFIELD COMMUNITY
�- CURRENTS
Welcome:
April -July, 2000
P•1
Summer camp is nearly upon us.
Town Officers:
Be sure to fill out and return the
p, 2
application forms as soon as
possible. They're in the center -fold,
Editorial Policy:
p. 3
along with information regarding
the camp. Just grab the pages and
3 4 '
give them a good tug.
pp.
Under the camp materials are the
Churches:
calendars. You can also pull them
pp. 4-7
out; they make good reminders
Grange:
when posted on the refrigerator.
pp, 7-8
No doubt, some of you will notice
that this newsletter is following
Sports:
8
closely on the heels of the previous
P.
one; the Enfield Community Council
• school News:
has changed the release dates of the
pp. 8-10
newsletter to fit major Enfield
activities such as the summer camp
Shannon's Youth:
pp. 10-11
and harvest festival more closely.
Please see the editorial policy and
12 Non -Contributors:
information for the new dates and
p.
p.
deadlines.
Businesses:
As always, if you have news or
pp. 12-14
announcements of interested to the
Aerobics:
Enfield community, please feel free
p. 14
to write and submit the article. If
Centerfold:
you'd like to list your business,
contact a member of the ECC.
camp forms
Businesses have a separate
and calendars
section now. If you'd like to
patronize local businesses, check it
out.
0
9
THE TOWN BOARD:
Town Supervisor:
Jean Owens
Phone: 273.5682
Dep. Supervisor/
Councilman: Greg
Stevenson
Phone: 273.2439
Councilman: Joseph
Schrer
Phone: 273.3350
Councilman: Mark
Roach
Phone: 273.4362
Councilman: Bob Holly
Phone: 272.5075
TOWN PHONE
NUMBERS:
Town Hall: 273.8256
Highway Dept.:
272.6490
Town Court: 273.0360
ENFIELD TOWN
OFFICIALS:
Town Clerk: Alice Laue
Phone: 272.1690
Deputy Town Clerk:
Diann McFall
Justice: Betty Poole
2
Justice: Jane Murphy
Highway Supt.: Ron
Updike
Phone: 387.9812
Deputy Highway Supt.:
Ron McFall
Phone: 272.7993
Town Historian: Sue
Thompson
Phone: 272.6412
ENFIELD COMMUNITY
COUNCIL:
President: David Albrecht
Phone: 272.4736
Vice President: Rob
Ainsley
Phone: 273.2258
Treasurer: Carol Givin
Phone: 273.7434
Secretary: Vera Howe -
Strait
Phone: 273.1413
Currents Editor: Marla
Perkins
EDITORIAL POLICY
AND CURRENTS
INFORMATION:
•
0
C
This newsletter is
published three times
per year (April, August,
December) and is
mailed to 822 Enfield
residents. The news-
letter comes out on the
15tb of the publication
months. The deadline
for contributions is the
1st of the publication
month.
If you have news of
interest to the Enfield
community, either of
general interest or of
community service
nature, that you'd like
to print in Currents,
send it to a member of
the Enfield Community
Council.
The opinions
presented in this
newsletter are those of
the persons or groups
that submit items and
do not necessarily
reflect the opinions of
the editor or members
of the ECC.
Currents welcomes
contributions from all
Enfield town residents
regarding events and
services available to
Enfield town residents.
All ECC programming,
including this
newsletter, is made
possible in part through
funding by the United
Way of Tompkins
County.
io
A UnHM Wny PMkJp fang AgOMY
HISTORIAN'S
REPORT
By Sue Thompson
In Buffalo, New York,
on May 20, 1901, the
Pan American
Exposition opened. It
was a dedication day of
the Great Six Month's
Festival —a World's Fair.
The whole Exposition
was a compact yet
complete presentation of
Twentieth Century
civilization of the
western world.
In 1899, construction
began on 350 acres of
land owned by the
Rumsey family (part of
the Enfield Rumsey
family?). When
completed, the
exposition ground, with
3
•
0
r]
their irregular lakes,
(lowering shrubs, and
rare trees, became the
most picturesque of
Buffalo's famous park
system.
In September, while
visiting the Exposition,
US President William
McKinley fell to the
bullet of an assassin.
The "Ithaca
Democrat Newspaper"
reported on November
7 in an Enfield Country
news article that at the
end of October, 1901,
Mr. Frank Noble of
Enfield visited the Pan
American Exposition.
What a trip that must
have beenl Do you
suppose he wrote
about his trip in a
diary or made a
scrapbook of the
memorabilia he
collected?
If you would like to
know more about the
Exposition, check out
this web site and book:
http://www.buffalo.ed
u/
UBT/featuresIb.html
4
America: Buffalo Pan-
American Exposition
(Arcadia, 1998).
CHURCHES
Amazing Grace
Fellowship
By Robert Lovelace
P.O. Box 208
1891 Trumansburg Rd.,
Ulysses Square
Jacksonville, NY 14854
607.387.3509 (office)
607.275.9121 (home)
Amazing Grace
Fellowship is an
independent, Full -Gospel
church where our motto
is, "We grow people." It is
our desire to create an
environment where
individuals can mature
spiritually and
emotionally as we each
discover God's plan for
our lives and what we can
contribute to this world
we live in. It is our desire
to have dynamic,
contemporary worship
and relevant messages to
meet the needs of the
people. Come join us.
J
Regular services:
9:15a.m., Sundays:
Sunday School
10:OOa.m., Sundays:
Worship Service
6:OOp.m., Sundays:
Youth Program
7:OOp.m., Tuesdays:
Home Meetings (for
adults)
Upcoming events:
Just 4 YOUth 2000
main event at the
Trumansburg
Fairgrounds, July 6-8;
included are on -site
camping, daily
activities (competitive
and non-competitive),
contemporary rock
music, and dynamic
guest speaker Carol
Kornacki.
If you would like more
information, please call
the Reverend Robert
Lovelace at 275.9121.
Enfield United
Methodist Church
By Scott Mosely
7 W. Enfield Center
Rd.
Pastor Scott Mosely
607.564.9076 (home)
0
Regular services:
10:00a.m., Sundays:
Sunday School
11:00a.m., Sundays:
Worship Service
6:30p.m., Sundays:
Youth Group
7:00p.m., Wednesdays:
Choir Practice at
Florence and Harold
Laue's House
Upcoming events:
7:00p.m., Thursdays:
Lenten Bible Study
(until Easter)
7:O0p.m., April 20:
Maundy Thursday
Service (Last Supper)
7:O0a.m., April 23:
Easter Sunrise
Service, a joint
service with the
Enfield Baptist
Church. it will take
place behind the
Baptist church, up on
the hill. A
continental breakfast
at the Enfield United
Methodist Church
will follow the service.
11:00a.m., April 23:
Easter Service (no
Sunday School)
6:30p.m., May 11:
5
LJ
Mother's Day Meal
(more details
available later;
contact Pastor
Mosely)
4:30p.m.-whenever,
May 20:
Smorgasbord to send
children to summer
camp
Agape Bible Church
By Mike Corriero
We welcome you to join
with us Sunday
mornings at 9:30a.m.
for our worship service.
Nursery is available
during the entire
service for children
ages 0-3 years.
Our Junior Church
and Teen programs are
forages 4-12 and 13-
19, respectively, and
meet following our
praise and worship
time. Teaching and
prayer ministry take
place in the sanctuary
and is for adults and
anyone who desires to
receive this ministry.
Our fellowship
brings people together
from all parts of the
Tompkins and Seneca
6
County areas, including
Cornell University, Ithaca
College, and Watkins
Glen.
Our message is a life -
changing personal
relationship with Jesus
Christ. Callus at 273
7419 for more information
about mid -week Bible
studies, prayer meetings,
and fellowship groups.
We also invite you to
watch our Time -Warner
cable TV program, "God is
Greater," on channel 78,
Fridays at 6:OOp.m. and
Wednesdays at 8:OOp.m.
It also airs on channel 13
on Sundays at S:OOp.m.
"Seek the Lord and His
strength; seek His face
continually." Psalm 105:4
GRANGE NEWS
By Roger Hubbell, Grange
Master
The Enfield Valley
Grange, 295, is probably
the oldest organization,
excluding the churches,
in the Town of Enfield. It
started and was chartered
by the National Grange
back in 1875.
Later this year, we
will be celebrating our
125 years with a
dinner and awards
ceremony honoring
those members who
have 25, 50, 55, 60,
65, 70, or 75 years of
continual membership
in our grange.
This year, we are
holding numerous
fund-raising events for
new siding on our
grange building.
Upcoming fund-raisers
are
April 29: Pancake
breakfast at grange
hall
May 6: Smorgasbord
dinner at the grange
hall.
There will be other
fund raisers
throughout the
summer and fall, so
keep watch for these
events.
The grange is always
looking for new
members. We meet
the 2^a Tuesday of
each month at
8:OOp.m. Everyone is
welcome. Come and
find out what the grange
is all about and what it
has to offer. We have
many family programs.
We have lots of
literature explaining all
of the programs and
benefits available to
you.
Our grange is one of
the two left in this
county, and our
building is the last
grange hall left in the
county. We do not want
to lose it. That is why it
is important to us to
keep and expand our
membership.
Also, if you'd like to
contribute to the
preservation of this
grange hall, please send
your tax-deductible
contribution to
Enfield Valley Grange
11295
c/o Roger Hubbell,
Grange Master
301 W. Enfield Center
Road
Ithaca, NY 14850
COMMUNITY
BASKETBALL
By David Albrecht
Basketball ends on
Friday, June 23rd. It
will resume in the fall.
ENFIELD SCHOOL
NEWS AND YEAR
TWO OF THE 21 ST
CENTURY
COMMUNITY
LEARNING CENTER
GRANT
By Mary Cole
This is our second full
year with the federal
grant awarded to
Enfield Elementary,
BJM Elementary, and
DeWitt Middle Schools.
It will last one more
year.
The grant provided
additional funding for
Enfield's homework
club. Third graders
attended two
days/week with 4th and
5ch graders
participating four
days/week from
2:00p.m.-4:00p.m. The
13
children received bus -
rides home afterwards.
Enrichment has
progressed throughout
the school year. We have
offered quilting, porcelain
flower making, crafts, fly-
fishing, winter garden
science, board games, etc.
Participants in this
program also received
bus -rides home.
This year, we were able
to expand our basketball
program. Girls and boys
practiced two days/week.
There were also games
between the elementary
schools in the district.
Parental support for this
program and another new
program, chorus, was
great. Parents of 3rd, 4"',
and 5th graders dropped
off their children two
days/ week at 7:15a.m. so
that the children could
participate before school.
On superintendent's
conference days in
October and March,
Enfield students (38 and
60, respectively), along
with BJM students, went
to Stewart Park and the
Ithaca Youth Bureau for
day -long activities, food,
•
and fun. In March, 51h
graders from Enfield
and BJM went to
DeWitt for the day to
become acquainted
with the middle school
they will attend in the
fall.
Starting in
December, 1999, and
continuing into May,
2000, six 511, grade
students from both
Enfield and BJM have
gotten together on
Friday afternoons to be
part of the Urban -
Rural Adventure Club.
Each session lasted
three weeks, with new
students each time.
The groups worked on
activities to build trust
and cooperation
among the children
and participated in
recreational activities
such as ice-skating,
swimming, and
watching movies.
Supper and
transportation home
were also part of this
activity. In May, there
will be a reunion for
the children at the
Cayuga Nature Center.
In the fall at Dewitt, we
hope at there will be
many "Hi, how are
you?"'s and smiles
among the children
involved in this group.
Enfield School and
the Enfield Community
Council worked together
on the grant this year to
provide basketball
uniforms for the
students and to set up a
better system of
communication to
enhance collaboration
between the groups.
If you have any
questions about the
grant or the school,
please call Mary Cole at
274.6838.
SHANNON's NEWS
FOR YOUTH
By Shannon McSurely,
Enfield Youth Program
Manager
If you would like more
information about any
of the events listed here,
would like to register for
an event, or would like
to be on Shannon
McSurely's mailing list
9
to receive monthly
calendars, call her at
272.2292, ext. 229. If
she's not available
when you call, leave
your name, age,
address, and telephone
number on her voice
mail.
If you lose your
calendar, you can look
at a copy in the show-
case at the Community
Building on Main St. in
Enfield, on the Rural
Youth Services bulletin
board in the DeWitt
lunch room, or at the
Valley Korners Grocers
on the corner of Rt. 79
and Rt. 327.
Upcoming events:
Prime Time Youth
Leadership Conference
This conference will
take place on May 6 in
Lansing. We are
looking for some
40
Enfield students who are
currently in 7th, 8th, or 901
grades to spend the day
learning how to be leaders
in society. Transportation
is available. Anyone
interested in being invited
or who would like more
information should
contact Shannon
McSurely.
Mechanical Maintenance
Workshop
Enfield's own all-star
mechanic, Marty
Schreiber, will lead a
workshop on the basics of
car care on Saturday, May
13, at the Youth Bureau
from 1:00-3:00p.m.
Transportation is
available. Limited
space —please register
by May 6.
Counselor -In -Training
(CPI') Summer Program
This provides an
opportunity for young
teens (13-1 S years old)
to receive training and
work with counselors
during the summer.
sA ire
The combination of
workshops and hands-
on experience provide
an excellent
background for young
people hoping to
become counselors
when they are 16.
Participants receive a
small stipend. There
will be an information
meeting some time in
early June, and there
will be interviews soon
after. The dates will be
available by the 2nd
week of May, so call
after that for details.
11
Shannon thanks
those of you who pursue
common sense and do
what you know to be
right.
The Enfield Community
Council and Cornell
Cooperative Extension
of Tompkins County
sponsor the Enfield
Youth Program.
NON -
CONTRIBUTORS
Unfortunately, not
everyone the editor
contacted about
deadlines contributed
an article about their
organizations. The
following is a list of
people/ organizations
from whom/which there
is no information at this
time:
Eric Rumsey, Cemetery
Committee;
Dorothy Pallandino,
United Way;
Jack Osburn, Enfield
Baptist Church;
Pam Whitaker, Ladies'
Firemen's Auxiliary;
Diana Anderson,
Community Volleyball;
Vera Howe -Strait,
After -School Program;
Nancy Oltz, T-CAT;
Denny Hubbell, Enfield
Fire Co.;
Jean Owens, Town
Supervisor;
Joseph Schehr,
Councilman;
Seniors (the editor is
uncertain of and has
been, to date, unable to
discover the name and
contact information of
the person in charge of
the seniors' group; if
you know about this,
please contact a
member of the ECC).
ENFIELD
BUSINESSES
Agate Lamp
Therapeutic Massage
Marla Perkins, MA,
LMT
273 Black Oak Rd.
273.5664
PI Talcl_ll_llpo yahoo.
C0111
12
•
Applegate Tree Farm
Phil and Mary White
348 S. Applegate Rd.
273.3155
Cascadilla Tree Care
John Friedeborn, Karen
Anderson
877 Bostwick Rd.
272.5447
CCB, Inc.
Brenda Watkins,
Manager
Construction and
Property Management
Enfield Main Rd., P.O.
Box 547
277.0332
Dan's Fuel Service, Inc.
Fuel Oil, Kerosene,
Gasoline, Diesel Fuel
Same day service
Dan Achilles
2102 Mecklenburg
Rd.
272.0679
DL Achilles Trucking
Dan Achilles
2102 Mecklenburg
Rd.
272.0679
ET Discount
Railroad Ties
Earl Tuttle
216'/z Elmira Rd.
277.7444
Facial Enhancements
Brenda Watkins
Enfield Main Rd.,
P.O. Box 547
256.0364
www.cnygifts.com/
facial.htm
H & H Auto Sales
Ken and Randy
Hoover
644 Enfield Falls
Rd.
277.5253
Hillendale Golf Course
Darleen
218 N. Applegate
Rd.
273.2363
Johnny's Wholesale,
Inc.
John Nino
56 S. Applegate Rd
272.6261
Lambchop Hill
Ceramics
Jim and Mary
Linten
19 Shudaben Rd.
277.3998
0
Night Owl Construction
Building, Remodeling,
Sheds, Decks,
Roofing, Siding,
Papering, Baths,
Kitchens, Electrical,
Plumbing
No job too small
Stephen L. Givin
139 E. Enfield Ctr.
Rd.
273.7434
saivin(aaol.com
Pellegrino's Saab
Service
Nicholas
2282 Enfield Main
Rd.
272.8259
Plumbing and Heating
Repairs
Jack Kulp
228 S. Applegate Rd.
273.2632
Shadetree Auto
John Grady
1047 Teeter Rd.
277.5959
Valley Korners Grocers
Dan and Diane
Achilles
2102 Mecklenburg
Rd.
273.6015
i3
AEROBICS
By Annemiek Haralson
A certified aerobics
instructor leads classes
at the Enfield school on
Tuesdays and
Thursdays, 6:45p.m.-
7:45p.m. The price
depends on how many
people sign up per
session. If you'd like
more information, call
Iody Boronkay at
272.6712 or Annemiek
Haralson at 273.0419.
14
• Dates: Wednesday, July 5 -Friday, August 11:
Time: 9 a.m.-2 p.m.
Ages: 4-13. There is a counselor in training program for 14 and 15 year olds.
Breakfast/Lunch:Provided free of charge by the Tompkins County EOC program,
campers can also bring their own lunches
Cost for six weeks of camp: 1 Child-$75.00 ; Second child-$35.00; More than two
children - $130.00 total. All fees must be sent with registration.
Before Camp Day Care: 7:30-9:00 a.m.
1 child-$2.50 per day/$75.00 for six weeks
extra children-$1.50 each child per day/$45.00 for six weeks
*****All children who will be attending before camp MUST be signed up the
previous week, there will be no more day -today drop -ins because we are
unable to coordinate the staffing.******
After Camp: 2:00-5:30 p.m.
1 child-$6.00 per day/$180.00 for six weeks
extra children- $4.00 per child per day/$120.00 for six weeks
*****All children who will be attending after camp MUST be signed up the
previous week, there will be no more day-to-day drop -ins because we are
unable to coordinate the staffing.******
What should my child bring to camp?
They should bring a swim suit, 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. We discourage electronic devices such as walkmen, gameboys, etc.
Questions???
Call Tonia Clate at home: 767-0178 (anytime)
cell phone 227-0773 (evenings)
Please makes checks payable to E.C.C. Completed applications and fees should be
returned to Enfield Elementary School or mail it to:
Tonia Clate.
809 Johnson Street
Elmira, New York 14901
########################################################################
IMPORTANT! IMPORTANT! IMPORTANT! 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 sent to the Tompkins County EOC Program.. The
only parts that need to be completed are Items1, 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.,
########################################################################
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#
1.
2.
List those authorized to pick up this child:
Name Relation Home# Work#
1.
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 Concerns 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 permission to participate in the Enfield Community Council Summer
Camp program. I understand that the ECC is not responsible for any accidents or injuries
unless there is negligence on their part.
Parent/Guardian Date
My child will be using before 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.
40
i Atichtneta A -I
SUMMER FOOD SERVICE PROGRAM
IIIGG18IIM FORM FOR CAMPS AND E=LLFD Srm '
PART 1
Child's Name: _
y,st rust ni.t.
• PART 2A - HOUSEHOLDS NOW GETMG FOOD STAMPS, AFDC OR FDPIR BENEFITS: Complete
this part and sign the statement in Part 3 - DO NOT complete Part 2B-
Food nor too wsc AFDC desfiessea twhc
FDPR rortm. weer
PART 2B - ALL OTHER HOUSEHOLDS: If you did not complete Part 2A, complete this part and sign
the statement in Part 3.
NAMES ==RENT INCOMEMMQUENCY
No. of itanobld Fps oar west Wdhm Chu Soppon. Nyram eras pier, ranays ben Jr 2
Molds msfoos . Md. Drumose) Alooeor I aso,vlml, or sq tslee, b�
SPrr. Dsv d Ch W.) Jab 1 Saud Srtry
PART 2C - FOSTER C'Em : Complete ibis part and sign the statement in Part 3. If this is a foster child
check here [ ] and write the child's income and how often it is received here: S /
PART 3 - SIGNATURE: An adult household member must sign the statement before it be approved.
PENALTMS FOR MISREPRFSENrATION: I ceruy that all of the above ioformatiw is [stir and correct sad that the food camp.
AFDC. or FDPIR number is cacao or that all 'meanie is feporfed. I tmdanaad that this infoemMian is being gives, for the receipt of
Fedenl funds: that insumtion officials may verify the information an the natemcot and to= the deliberate murapfecoudw of use
information may, subject me to prmeattim under applicable State and Federal laws.
Signature or adult: Social security nlnnber
Printed scone or adult:
• uate sirnen Nome teleohnne Waft tedenhone Home address us, cone
PART 4 - RACLU-ETENIC IDENTITY: You are not required to answer this question.
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—.,of are lnesedd rinmYr ..ever Cu court r r uduurm W. elm heneaolC reenter actor to mum.n Cot col Peura ..1 ....any oo M .
Ploereree of .earl wmy rrrhs, as a ."-any. Ma if. col turret .taco u es,. p Wos or on lMwrrn a es,. ire eel to rult eaurbdC lose R
aamrc fh. moor Coos sr M. eon, r aurrm uaa.. ho aryreea Teo seuol � oo a auy to cuss r drufy see emraeW rater r urryl,rr em
eery r .wi(y M mrnrr d tbrreom arW r M asr.rr Theo wnfaaer elfaru cosy M umr ae. rrvre Pmrnm mu.o. welt, od arrrremao
er col rerM OIYeOmr 000lo)srs se MW W RA{. eWpraa . foes W. A , or ram ofree to O6emYM a.nnl ew(uYrn for r or tYJ
.err. AFDC. or FDPR grebe, esromar to Son gbyr rerr.Y alF r Caamm ar ewrrn el hemfnr rs...r er d kos, tlr aarremsor
pwuor y w emw.b aces r FY.. r err d rear. ra.r TDB ortw ry .rrl. s o pu e. rmunYn of bw(Y. rrm.ner err.. Y MI
unto if rsr,a a,bnao,s u nlor,r.
The Sur. Fend jR9 F/ejnr (er ChrlaM rr Y YYd eppleeWlJ F.erren. If yr eeW.. eel )m er .lryera Ye eYrl /Yer.mNlee ayeW. aeWY of rR.
eider. a.. awd CrVra. era, eta. or dasdAq, auo aaeudurry r. AJmranrr. Fend and Ce vtor Son+ee. U.S. Dg nlms of Arnurlun. 3101 Nrt Coror
Dore. AW . VA 29@.
For Sponsor Use Only: Food Men fAFDC/FDPIR household czaegoneaby eligible free [ ] Yes ( ] No
MONTHLY INCOME CONVERSION: WEEKLY X 4.33. EVERY 2 WEEKS X 2.15, TWICE A MONTH X 2
Total family income' Family size:
Eligible: NOT Eligible:
Daertnfnmg official: Stgnstrare: Date
AmChmem A-2
ELIGIBILITY FORM FOR CAMPS AND ENROLLED STIES INSTRUCTIONS
• Please complete the Summer Food Service Program Eligibility Form for Camps and Enrolled Site using the inscmioos below
Sip the form and teams it to the grodatiag orgmtah®. Call the sponsor if you used help:
PART I - PARTICIPANT'S INFORMATION: All HOUSEHOLDS COMPLETE THIS PART.
(1) Print the maxis of your own housebold's child.
PART 2A - HOUSEHOLDS GETTENG FOOD STAMPS OR AID TO FAum.tFS WITH DEPENDENT CEIELM N
(AMC) OR FOOD DIST'RrOUTION PROGRAM ON INDIAN RESERVATIONS (FDPIR) RENEFLTS: COMPLETE
THIS PART and PART 3.
(I) Liu your eurrmt food stamp cans: number or your AFDC or FDPIR identifsotioo number for the Parti iPatu. Do nor
complete Past 2B.
(2) An adult household member most sip the uatemem in PART 3.
PART 23 - ALL OTHER HOUSEHOLDS COMPLETE THIS PART and PART 3.
(1) Write the names of everyone in you household.
(2) Write the amount and the frequency of income (.a, weekly, every two weeks, twice a month, or monthly) received last
month for each household member. This income is the amount before Hass on anything else is takm out, sod where it ceme
from, web as earnings, welfare, Pemsiom, and other moccut (refer to examples below for types of income to report). If
my amount last month was; metric or ins than usual, wore rust peram's usual income.
(3) An adult household mamba must sip and give his/her social security number in PART 3.
PART 2C - FOSTER CHD.D: COMPLETE THIS PART and PART 3.
(1) Wrist: the fester child's mouthly 'personal us' income. Write '0' is the foster child does not get -personal use' immune,
(2) A foster parent or other official representing the child most sign the form.
PART 3 - SIGNATURE AND SOCIAL SECURITY NUMBER: ALL HOUSEHOLDS COMPLETE THIS PART.
(1) All eligibility forms must have the signature of an adult household member,
(2) The adult household member who signs the statement must include his/her social security number. If he/she does not
have a social security number, write 'uone' or something else to show that he/she does not have a social security number.
If you listed a food sump. AFDC, or FDFM number, a social security number is not oceded.
PART d - RACIAL/ETHNIC IDENTITY: COMPLETE THE RACIAUETHNIC IDENTITY QUESTION IF YOU WISH.
• You are not required to answer this question to get meal benefits. However, this information will help t utwe that everyone
is treated fairly.
F�rmncs fmm Enmimvment
wagNaaLnes/vp+
Strike bettefts
usemploytaon compensation
Worker's eompau'oon
Net itseome from scl(ewmd
business w face
We14re/Child Surwvnr/AUim
Public assistance payawra,
Welfare paynttatts
Ahmonyichild support paymsems
0
INCOME TO REPORT
Pennm,tfaeoretne Sneial Secu.ry
Pmsimrer
Supplemental Security Income
Rear men utcome
-man s paymetm
Social security
Other Income/Self<melevmem
Disability bemefcs
Cash vmhdrawn from savings
Weeestldt..dends
Income from--otastsl
investments
Regular contributions from
persons not living in the
household
Net Wyaltesh,uwmes/
oct rental tncomc
A" Other income