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FOOD PANTRY DISTRIBUTION LOG Date:___ Agency Name:___Name please print I hereby verify a need for food. Food is for private use and not for sale or barter.AdultsChildrenSeniors(1859)(017)(60+)First visit since January 1 Yes# in HH1 2 3 4 5 6 7 8 9 10 11 12 13 14 15Put Totals HereWe believe that no one should go hungry.No
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