EXHIBIT G                             THE EMERGENCY FOOD ASSISTANCE PROGRAM MANIFEST                     (Rev. 06/04)

( __________________ ) AREA SITES

         Area Office                                 Delivery Date:__________________

NAME OF ORGANIZATION

NUMBER OF CASES ALLOCATED TO ORGANIZATION

(List foods below received during shipment.)

SIGNATURE OF
REPRESENTATIVE

Total Number of Cases

 

 

_____________        _____________       _____________        _____________         _____________        _____________        _____________

____________________________________

Signature of Area Director or Representative

This institution is an equal opportunity provider.

8-G

Example Peaches