SENIOR FARMERS MARKET NUTRITION (VOUCHER) PROGRAM ACTIVE ADULT CENTER LISTING TO BE ELIGIBLE, YOU MUST MEET ALL REQUIREMENTS Be a resident of Luzeme or Wyoming County -Be at least 60 years of age by December 31, 2022 Meet income guidelines based on 2022 Total Household Income: (All income is included, Le Social Security, Pension, Unemployment Compensation, etc)-Self declaration. The federal stimulus checks do not count as income for determining income eligibility for the SFMNP checks. BUTLER TWP ACTIVE ADULT CENTER 411 W. Butler Dr., Drums, PA 570788-4881 CHARLES T. ADAMS ACTIVE ADULT CTR 5E. Market St, Wilkes-Bame, PA 570 825-3484 DALLAS ACTIVE ADULT CENTER 1158 Twin Stacks Dr., Dallas, PA 570 675-2179 FALLS ACTIVE ADULT CENTER Program officials may verity eligibility information. 2013 Sullivan's Trail, Falls, PA 570 388-2623 1 Person Household $25,142 or less 2 People Household-$33,874 or less FREELAND ACTIVE ADULT CENTER 3 People Household-$42,606 or less 701 Chestnut St, Freeland, PA 570 636-3080 4 People Household-$51,338 or less HAZLETON ACTIVE ADULT CENTER 24 East Broad Street, Hazleton, PA 570 459-1441 JEWISH COMMUNITY CENTER The Senior Farmers Market Nutrition Program (SFMNP) Application shown with this press release must be completely filled out, signed by the eligible participant and then mailed or emailed to our agency. The distribution by mal will be done from June through September 29, 2022-applications received after the deadline date of Thursday, September 29th will not be accepted 613 SJ. Strauss Lane, Kingston, PA 570 824-4646 KINGSTON ACTIVE ADULT CENTER 335 Third Ave, Kingston, PA 570 287-1102 LEE PARK ACTIVE ADULT CENTER This year two participants can be included on one application as long as they live at the same address. EACH participant must complete their part of the application and BOTH signatures must be on the application, or it will not be processed. Proxy forms WILL NOT be required this year you will be allowed to have someone pick up your fruits and vegetables in your place with the vouchers. It is important that your name and address are printed dearly and legibly in order to expedite the process of mailing out the vouchers. 140 Lee Park Ave, Wilkes-Bane, PA 570-825-9883 MOUNTAINTOP ACTIVE ADULT CENTER 460 S. Main Rd, Mt. Top, PA 570 868-8517 PITTSTON ACTIVE ADULT CENTER 441 N. Main Street, Pittston, PA 570 655-5561 PLAINS ACTIVE ADULT CENTER 50 Second Street, Plains, PA 570 824-5542 PLYMOUTH ACTIVE ADULT CENTER PLEASE NOTE: 1) Each qualitying individual is allowed four (4) $6 vouchers for a total SFMNP benefit of ($24) ONE TIME per program year. 160 East Main Street, Plymouth, PA 570 779-9664 ROSE TUCKER ACTIVE ADULT CENTER 2) A person is not eligible if he/she resides in a nursing home, con vent or residential facility where meals are prepared. 145 East Green St, Nanticoke, PA 570 735-1670 SHICKSHINNY ACTIVE ADULT CENTER SFMNP applications are also available for pickup at any of our Active Adult (Senior) Centers listed on AAA/Luzerne Wyoming Counties agency website: www.luzemmecounty.org under Dep -Area on Aging-News; and from your local legislature's office. 19 W. Vine Street, Shickshinny, PA 570 542-4308 WYOMING COUNTY ACTIVE ADULT CTR 101 Dymond Terrace, Tunkhannock, PA 570-836-2324 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF AGRICULTURE SENIOR FARMERS MARKET NUTRITION PROGRAM 2022 APPLICATION FORM TO QUALIFY YOU MUST BE 60 OR OLDER (OR TURN 60 BY 12/31/2022) AND MEET THE HOUSEHOLD INCOME GUIDELINES RIGHTS AND RESPONSIBILITIES of my knowledge This bed in section gement or intendo thentionaly making dey concesing The to me and maybede oor oinnal proses Standard for by and propation in the S the same for everyone agediy and that may appeal any decision made by the local agency regarding my ebity to the S By signing this, I acknowledge that my total household income is within the Income guidelines: $25,142 for 1 person in the household; or $33,874 for 2 people in the household and that I am 60 years old or older (or will turn 60 by December 31, 2022). 1st Participant Name (Print): Birth Date Person checks are for Signature 2nd Participant Name (Print): Birth Date Person checks are for Signature MUST COMPLETE ALL LINES Address (Print): Telephone Number: Please circle all that apply Ethnicity: Hispanic or Latino Not Hispanic or Latino Race: American Indian or Alaskan Native Asian Black or African American Native Hawaian or other Pacific Islander White Please mail or email your completed form before September 29, 2022 to: Area Agency Aging for Luzere & Wyoming Counties, 93 North State St, Wilkes Barre, PA 18701 or Karen Pietracini@mecounty.org THIS INSTITUTION IS AN EQUAL OPPORTUNITY PROVIDER prike and s Deparve V Signature County You Live Inc SENIOR FARMERS MARKET NUTRITION ( VOUCHER ) PROGRAM ACTIVE ADULT CENTER LISTING TO BE ELIGIBLE , YOU MUST MEET ALL REQUIREMENTS Be a resident of Luzeme or Wyoming County -Be at least 60 years of age by December 31 , 2022 Meet income guidelines based on 2022 Total Household Income : ( All income is included , Le Social Security , Pension , Unemployment Compensation , etc ) -Self declaration . The federal stimulus checks do not count as income for determining income eligibility for the SFMNP checks . BUTLER TWP ACTIVE ADULT CENTER 411 W. Butler Dr. , Drums , PA 570788-4881 CHARLES T. ADAMS ACTIVE ADULT CTR 5E . Market St , Wilkes - Bame , PA 570 825-3484 DALLAS ACTIVE ADULT CENTER 1158 Twin Stacks Dr. , Dallas , PA 570 675-2179 FALLS ACTIVE ADULT CENTER Program officials may verity eligibility information . 2013 Sullivan's Trail , Falls , PA 570 388-2623 1 Person Household $ 25,142 or less 2 People Household- $ 33,874 or less FREELAND ACTIVE ADULT CENTER 3 People Household- $ 42,606 or less 701 Chestnut St , Freeland , PA 570 636-3080 4 People Household- $ 51,338 or less HAZLETON ACTIVE ADULT CENTER 24 East Broad Street , Hazleton , PA 570 459-1441 JEWISH COMMUNITY CENTER The Senior Farmers Market Nutrition Program ( SFMNP ) Application shown with this press release must be completely filled out , signed by the eligible participant and then mailed or emailed to our agency . The distribution by mal will be done from June through September 29 , 2022 - applications received after the deadline date of Thursday , September 29th will not be accepted 613 SJ . Strauss Lane , Kingston , PA 570 824-4646 KINGSTON ACTIVE ADULT CENTER 335 Third Ave , Kingston , PA 570 287-1102 LEE PARK ACTIVE ADULT CENTER This year two participants can be included on one application as long as they live at the same address . EACH participant must complete their part of the application and BOTH signatures must be on the application , or it will not be processed . Proxy forms WILL NOT be required this year you will be allowed to have someone pick up your fruits and vegetables in your place with the vouchers . It is important that your name and address are printed dearly and legibly in order to expedite the process of mailing out the vouchers . 140 Lee Park Ave , Wilkes - Bane , PA 570-825-9883 MOUNTAINTOP ACTIVE ADULT CENTER 460 S. Main Rd , Mt. Top , PA 570 868-8517 PITTSTON ACTIVE ADULT CENTER 441 N. Main Street , Pittston , PA 570 655-5561 PLAINS ACTIVE ADULT CENTER 50 Second Street , Plains , PA 570 824-5542 PLYMOUTH ACTIVE ADULT CENTER PLEASE NOTE : 1 ) Each qualitying individual is allowed four ( 4 ) $ 6 vouchers for a total SFMNP benefit of ( $ 24 ) ONE TIME per program year . 160 East Main Street , Plymouth , PA 570 779-9664 ROSE TUCKER ACTIVE ADULT CENTER 2 ) A person is not eligible if he / she resides in a nursing home , con vent or residential facility where meals are prepared . 145 East Green St , Nanticoke , PA 570 735-1670 SHICKSHINNY ACTIVE ADULT CENTER SFMNP applications are also available for pickup at any of our Active Adult ( Senior ) Centers listed on AAA / Luzerne Wyoming Counties agency website : www.luzemmecounty.org under Dep -Area on Aging - News ; and from your local legislature's office . 19 W. Vine Street , Shickshinny , PA 570 542-4308 WYOMING COUNTY ACTIVE ADULT CTR 101 Dymond Terrace , Tunkhannock , PA 570-836-2324 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF AGRICULTURE SENIOR FARMERS MARKET NUTRITION PROGRAM 2022 APPLICATION FORM TO QUALIFY YOU MUST BE 60 OR OLDER ( OR TURN 60 BY 12/31/2022 ) AND MEET THE HOUSEHOLD INCOME GUIDELINES RIGHTS AND RESPONSIBILITIES of my knowledge This bed in section gement or intendo thentionaly making dey concesing The to me and maybede oor oinnal proses Standard for by and propation in the S the same for everyone agediy and that may appeal any decision made by the local agency regarding my ebity to the S By signing this , I acknowledge that my total household income is within the Income guidelines : $ 25,142 for 1 person in the household ; or $ 33,874 for 2 people in the household and that I am 60 years old or older ( or will turn 60 by December 31 , 2022 ) . 1st Participant Name ( Print ) : Birth Date Person checks are for Signature 2nd Participant Name ( Print ) : Birth Date Person checks are for Signature MUST COMPLETE ALL LINES Address ( Print ) : Telephone Number : Please circle all that apply Ethnicity : Hispanic or Latino Not Hispanic or Latino Race : American Indian or Alaskan Native Asian Black or African American Native Hawaian or other Pacific Islander White Please mail or email your completed form before September 29 , 2022 to : Area Agency Aging for Luzere & Wyoming Counties , 93 North State St , Wilkes Barre , PA 18701 or Karen Pietracini@mecounty.org THIS INSTITUTION IS AN EQUAL OPPORTUNITY PROVIDER prike and s Deparve V Signature County You Live Inc