Statement of Loss Request for Replacement Food Due to a 2025

1. Click ‘Get Form’ to open it in the editor.
2. Begin by entering your Client’s name, Client ID, and address in the designated fields. Ensure that all information is accurate to avoid delays.
3. Provide your phone number for any follow-up communication. This is crucial for DTA to reach you if they need further information.
4. Indicate the value of the lost food and specify the date of the household disaster or misfortune. Be precise with these details as they are essential for processing your request.
5. In the section describing the household disaster, provide a clear explanation of what occurred. This helps DTA understand your situation better.
6. Review all entered information for accuracy before signing. Your signature confirms that the information provided is true and acknowledges potential consequences of false statements.
7. Once completed, submit the form via your preferred method: upload through our platform, fax, mail, or scan at a local DTA office.

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