ࡱ> .0/ \p jcastaldo Ba==Lx8^W6CHILD CARE FOOD PROGRAMMEAL COUNT RECORD NCO/Rural Communities Child CareProvider Month/Year Breakfast 1:Snack 1:Lunch 1: Dinner 1: Breakfast 2:Snack 2:Lunch 2: Dinner 2:]Claim no more than 2 major meals and 1 snack or 2 snacks and 1 major meal per child per day.  NameageTIMEDAYINOUTBLDTOTALSI also certify thatxI have followed CCFP requirements on types and minimum amounts of foods served; I have claimed meals served to enrolled {children 12 years of age and under; I have claimed meals served to my own children only when they were fed at the same time{as day care children, AND ONLY IF I AM ELIGIBLE; I have claimed meals only within the limitations of my child care license;Qand that this Meal Count accurately reflects the number of eligible meals served.o SignatureDate YES!! My menus are enclosed8prosecution under applicable state and federal statutes.{connection with receipt of federal funds and that deliberate misrepresentation or withholding of information may result in {I certify that this information is true and correct in all respects; I understand that this information is being given in For Office Use OnlyNUMBER ENROLLEDADASNACKSINITIALSLower Lake, CA 95457Name Please Sign in Blue or Black InkSA/P/EDINNERLUNCH BREAKFAST"16170 Main Street / P. O. Box 1078 Rev. 4/07N(707) 994-4647 ext. 28 Forms due by the 5th day of the month following care. h Time meals are served (including shifts, if applicable): ` E8r0j'acc  Ec+{6a7  dMbP?_*+%&p= ף?'?(?)?MJamie's Printer4C odXXLegalDINU"4L5a"`XX??U} } $} m} } $}  m} } $} m} } } $} m EJ@V@w@<@@@ @ @  @  @ @ h@h@h@h@ h@h@h@h@h@h@h@h@h@h@h@h@h@h@ 1*222222222222222222 F*333333333333333333 *  B  4&&&&& 62"5,,,E,,, 6*5  4''N''' 64  ,,,,O, 6))C 5*((D% + ... + ..  %  %  ..% % ... % + w.. + ..  % % ..% % ... A - ( 00/////////// } R S \ ^T_ g+ d d ded g+ T f ddT ; U `av . U `av . U `av . < V  V   u  V  V  u V  V   u ~ h?*WbZ~WbZ|WbZ|~ i@*WbZ|WbZ|WbZ|~ i@*WbZ|WbZ|WbZ|  ~ i@*WbZ|WbZ|WbZ|~ i@*WbZ~WbZ|WbZ|~ i@*WbZ|WbZ|WbZ|~ i@*WbZ|WbZ|WbZ|~ i @*WbZ|WbZ|WbZ|~ i"@*WbZ|WbZ|WbZ|~ i$@*WbZ|WbZ|WbZ|~ i&@*WbZ|WbZ|WbZ|~ i(@*WbZ|WbZ|WbZ|~ i*@*WbZ|WbZ|WbZ|~ i,@*WbZ|WbZ|WbZ|~ i.@*WbZ|WbZ|WbZ|~ i0@*WbZ|WbZ|WbZ|~ i1@*WbZ|WbZ|WbZ|~ i2@*WbZ|WbZ|WbZ|D l<<P4JB<NFFTFFFFFFFFFFFFFF h@!h@"h@#h@$h@%h@&h@'h@(h@)h@*h@+h@,h@ -@ . /<@0123@45678<@9@:;@< = > @ ? ~ i3@* WbZ|WbZ|WbZ|!~ !i4@*!WbZ|WbZ|WbZ|"~ "i5@*"WbZ|WbZ|WbZ|#~ #i6@*#WbZ|WbZ|WbZ|$~ $i7@*$WbZ|WbZ|WbZ|%~ %i8@*%WbZ|WbZ|WbZ|&~ &i9@*&WbZ|WbZ|WbZ|'~ 'i:@*'WbZ|WbZ|WbZ|(~ (i;@*(WbZ|WbZ|WbZ| ( )~ )i<@*)WbZ|WbZ|WbZ|*~ *i=@**WbZ|WbZ|WbZ|+~ +i>@*+WbZ|WbZ|WbZ|,~ ,j?@*,XcY[XcY[XcY[-# -@-k]{Q# - @- k]{Q# -@-k]{Q. .l .m .! .n- .PP . l . m . ! . n- .PP .l .m .! .n-(/??????????? 0I$ 18# 28" 3H*3 49 4::::::::::::: 4 59 5::::::::::::: 69 6::::::::::::: 79 7::::::::::::: 7 "89:::::::::::::"9 9o 9$! 9$ :" :p,:qrsst>> : G: ;3 <%*< =& = =' =z =K1= M = K0 = LM = y/=z =( = =c)=,>KLLMKLMxMxyzLMKJJc?=D lFFFFFFFFTFFFFn,<@22@&RL<0@BCD @777@7B777777 B7C 7D7 < >-@>:====== <<  7 Oh+'0HPh| Leslie Smith jcastaldoMicrosoft Excel@+Y@tg4@xb?Y՜.+,0 PXd lt|  CCFP Meal Count-4 child%'CCFP Meal Count-4 child'!Print_Area  Worksheets Named Ranges  !"#%&'()*+Root Entry FrWorkbook7SummaryInformation(DocumentSummaryInformation8$Root Entry Fྼ671Workbook7SummaryInformation(DocumentSummaryInformation8  !"#՜.+,D՜.+,` PXd lt|  CCFP Meal Count-4 child%'CCFP Meal Count-4 child'!Print_Area  Worksheets Named Ranges4 $,