Attestation
Applicant Hereby Attests to the Following Statment
Under penalty of perjury, I hereby attest that I am 65 years of age or older, or age 60-64 with high risk as indicated by my stated medical condition; I live alone or only with another program-eligible adult; I am unable to prepare meals or access additional food resources as a result of the self-isolation period; I do not currently receive any assistance from a federal nutrition program and do not exceed the stated annual income of $74,940 as a single individual or $101,460 in a household of two. I agree to release my name, address, phone, email and dietary information to complete the appropriate referral to obtain restaurant meals.