DSS-1678. Replacement Affidavit - info dhhs state nc-2026

1. Click ‘Get Form’ to open the DSS-1678 in the editor.
2. Begin by entering your county and FNS case number at the top of the form. This information is crucial for processing your request.
3. Fill in the date of report and issuance month/year to provide context for your affidavit.
4. Complete your personal details, including your name and address, ensuring accuracy for correspondence.
5. In the 'Reason for Report and Replacement Action' section, clearly indicate whether food was destroyed or stolen. If applicable, specify the amount lost.
6. Review the certification statement carefully, acknowledging the penalties for providing false information before signing.
7. If necessary, have a witness sign if you are marking with an 'x' or other mark.
8. Finally, ensure all fields are completed before submitting it back to the Food and Nutrition Services Office within ten calendar days.

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