"Farmers' Market Health Bucks Redemption Form" - New York

Farmers' Market Health Bucks Redemption Form is a legal document that was released by the New York State Department of Agriculture and Markets - a government authority operating within New York.

Form Details:

  • The latest edition currently provided by the New York State Department of Agriculture and Markets;
  • Ready to use and print;
  • Easy to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a printable version of the form by clicking the link below or browse more documents and templates provided by the New York State Department of Agriculture and Markets.

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Download "Farmers' Market Health Bucks Redemption Form" - New York

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Coupon Program Redemption Form
Farmer Name:
__________________________
Make Check payable to:
__________________________
Mailing Address:
__________________________
__________________________
Phone:
Date:
__________________________
For confirmation of receipt, provide email address: _________________________________________________
FMNP Farmer Number:
Redemptions:
Coupon Type
Number of Coupons
($) Value
Farmers Market Health Bucks (NYC)
______________________
_______________
FreshConnect Checks
______________________
_______________
CNY Health Bucks
______________________
_______________
JSY Health Bucks
______________________
_______________
Total coupons
______________________
_______________
Coupon Program Redemption Form
Farmer Name:
__________________________
Make Check payable to:
__________________________
Mailing Address:
__________________________
__________________________
Phone:
Date:
__________________________
For confirmation of receipt, provide email address: _________________________________________________
FMNP Farmer Number:
Redemptions:
Coupon Type
Number of Coupons
($) Value
Farmers Market Health Bucks (NYC)
______________________
_______________
FreshConnect Checks
______________________
_______________
CNY Health Bucks
______________________
_______________
JSY Health Bucks
______________________
_______________
Total coupons
______________________
_______________
Coupon Program Redemption Form
Farmer Name:
__________________________
Make Check payable to:
__________________________
Mailing Address:
__________________________
__________________________
Phone:
Date:
__________________________
For confirmation of receipt, provide email address: _________________________________________________
FMNP Farmer Number:
Redemptions:
Coupon Type
Number of Coupons
($) Value
Farmers Market Health Bucks (NYC)
______________________
_______________
FreshConnect Checks
______________________
_______________
CNY Health Bucks
______________________
_______________
JSY Health Bucks
______________________
_______________
Total coupons
______________________
_______________
Coupon Program Redemption Form
Farmer Name:
__________________________
Make Check payable to:
__________________________
Mailing Address:
__________________________
__________________________
Phone:
Date:
__________________________
For confirmation of receipt, provide email address: _________________________________________________
FMNP Farmer Number:
Redemptions:
Coupon Type
Number of Coupons
($) Value
Farmers Market Health Bucks (NYC)
______________________
_______________
FreshConnect Checks
______________________
_______________
CNY Health Bucks
______________________
_______________
JSY Health Bucks
______________________
_______________
Total coupons
______________________
_______________
Farmers’ Market Health Bucks Redemption Form
Stamp the face of each coupon with your current FMNP endorsement stamp.
We recommend you send in redemptions monthly.
To guarantee reimbursement, final redemptions must be postmarked no later than:
Farmers Market Health Bucks: January 15
FreshConnect Checks: January 15
CNY Health Bucks: December 1
JSY Health Bucks: December 1
Complete this redemption form and mail with your stamped coupons to:
Farmers’ Market Federation of New York
117 Highbridge St, Suite U1
Fayetteville, NY 13066
Farmers’ Market Health Bucks Redemption Form
Stamp the face of each coupon with your current FMNP endorsement stamp.
We recommend you send in redemptions monthly.
To guarantee reimbursement, final redemptions must be postmarked no later than:
Farmers Market Health Bucks: January 15
FreshConnect Checks: January 15
CNY Health Bucks: December 1
JSY Health Bucks: December 1
Complete this redemption form and mail with your stamped coupons to:
Farmers’ Market Federation of New York
117 Highbridge St, Suite U1
Fayetteville, NY 13066
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