9

8

7

6

5

4

3

2

1

Licensed Capacity:

Name of Provider: John Houston - Let It Shine Childcare

I certify that I have followed USDA portion requirements and meal pattern guidelines. I am only claiming reimbursement for meals served to: (a) enrolled children of migrant workers 15 years of age and under, (b) mentally or physically disabled persons, as defined by the State, enrolled in an institution or child care site serving a majority of persons 18 years of age and under or (c) to enrolled Family Day Care children twelve (12) years old an dunder if they qualify.

Also, to the best of my knowledge, this home is not participating in the Child and Adult Care Food Program under any other Sponsoring Organization. I further certify that the meals served and attendance reported on this claim are true and correct in all aspects. I understand that this information is being given in connection with the receipt of Federal Funds; the USDA and the Department of Education officials may, for cause, verify information, and the deliberate misrepresentation may subject me to prosecution under applicable State and Federal criminal statutes. Date__________________________________________________________

Signature of Provider:______________________________________________

31 8 9 9 8 8 8 8 7 8 3 6 8 9 8 8 7 7 5 5 (Sat) (Sat) (Sat)
Daily Attendance

30 Closed (Sun) (Sun) (Sun) 12
Breakfast

29 5 5 6 5 5 3 6 5 6 2 3 4 6 7 7 4 4 2 2 8 9 9 8 8 6 8 7 8 2 6 7 9 8 8 7 7 5 5
AM Snack

28

27

26

25

24

23

22

21

20

19

18

17

16

15

14

13

12

11

10

9 8 9 9 8 8 6 8 7 8 2 6 7 9 8 8 7 7 5 5
Lunch

(Sat)

(Sun)

10 8 9 8 8 8 8 7 7 7 3 6 8 8 8 8 7 7 5 5 Month and Year: January 2007
PM Snack Supper

10 1 1 1 1 1 3 1 1 1 1 1 1 1 1 1
Night Snack

7 0 0 0 0 0 0 0
Total

6 38 42 42 38 38 34 37 33 37 12 28 35 42 40 40 33 33 23 23

6

9

9

10

9

9

FAMILY DAY CARE MONTHLY MEAL COUNT AND CLAIM FOR REIMBURSEMENT

10

10

9

9

1

1

1

0

0

47

45

43

168 106

112.36 189.08 360.51 661.95

I certify that I have followed and under, (b) mentally or p Family Day Care children tw Also, to the best of my know attendance reported on this Education officials may, for Signature of Provider:_____

163 163 163 20 0 783

9

8

7

6

5

4

3

2

1

Licensed Capacity:

Name of Provider: John Houston - Let It Shine Childcare

28 9 9 8 2 2 8 8 9 7 9 9 9 (Sat) (Sat) (Sat) (Sat)
Daily Attendance

27 (Sun) (Sun) (Sun) (Sun) 10 12
Breakfast

26 10 11 10 10 10 6 9 9 8 2 2 8 8 9 7 9 9 9 9
AM Snack

25

24

23

22

21

20

19

18

17

16

15

14

13

12

11

10

11 6 7 7 8 9 6 6 2 2 6 5 6 4 6 6 6 6 10 9 9 8 2 2 8 8 9 7 9 9 9 9 10 9 9 7 2 2 8 8 9 7 9 9 10 1 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 1 1 0 0 0 0 1 1 1 1 0 0 10 10 10 10 1 1 0 0 10 11 10 10 9 10 1 1 0 0 10 11 10 10
Lunch

10 Month and Year: February 2007
PM Snack Supper Night Snack

8

6

11

10

FAMILY DAY CARE MONTHLY MEAL COUNT AND CLAIM FOR REIMBURSEMENT

11

10

10

10

1

1

0

0

I certify that I have followed USDA portion requirements and meal pattern guidelines. I am only claiming reimbursement for meals served to: (a) enrolled children of migrant workers 15 years of age and under, (b) mentally or physically disabled persons, as defined by the State, enrolled in an institution or child care site serving a majority of persons 18 years of age and under or (c) to enrolled Family Day Care children twelve (12) years old an dunder if they qualify.

Also, to the best of my knowledge, this home is not participating in the Child and Adult Care Food Program under any other Sponsoring Organization. I further certify that the meals served and attendance reported on this claim are true and correct in all aspects. I understand that this information is being given in connection with the receipt of Federal Funds; the USDA and the Department of Education officials may, for cause, verify information, and the deliberate misrepresentation may subject me to prosecution under applicable State and Federal criminal statutes.

Total

Signature of Provider:______________________________________________

52

47

47

43

48

51

49

50

Date__________________________________________________________

42

37

10

10

39

38

43

33

43

43

43

45

0

0

0

0

0

0

0

0

0

0

0

171 118

125.08 196.04 366.42 687.54

I certify that I have followed and under, (b) mentally or p Family Day Care children tw Also, to the best of my know attendance reported on this Education officials may, for

Signature of Provider:_____

170 170 168 16 0 813

9

8

7

6

5

4

3

2

1

31 9 10 11 11 11 11 11 11 11 11 11 11 11 11 11 10 10 10 (Sat) (Sat) (Sat) (Sat)
Daily Attendance

30

29

28

27

26

25

24

23

22

21

20

19

18

17

16

15

14

13

12

11

10

10

10

10

8

Licensed Capacity:

(Sun)

(Sun)

(Sun)

(Sun)

(Sat) 7 8 8 9 7 9 8 9 7 8 8 8 6 5 6 7 10 10 12
Breakfast

Name of Provider: John Houston - Let It Shine Childcare

I certify that I have followed USDA portion requirements and meal pattern guidelines. I am only claiming reimbursement for meals served to: (a) enrolled children of migrant workers 15 years of age and under, (b) mentally or physically disabled persons, as defined by the State, enrolled in an institution or child care site serving a majority of persons 18 years of age and under or (c) to enrolled Family Day Care children twelve (12) years old an dunder if they qualify.

Also, to the best of my knowledge, this home is not participating in the Child and Adult Care Food Program under any other Sponsoring Organization. I further certify that the meals served and attendance reported on this claim are true and correct in all aspects. I understand that this information is being given in connection with the receipt of Federal Funds; the USDA and the Department of Education officials may, for cause, verify information, and the deliberate misrepresentation may subject me to prosecution under applicable State and Federal criminal statutes. Date__________________________________________________________

Signature of Provider:______________________________________________

230
9 10 11 11 11 11 11 11 11 11 11 11 11 11 11 10 10 10
AM Snack

10

10

8

8

176
9
Lunch

10

10

10

8

Month and Year: March 2007

230
10 11 11 11 11 11 11 11 11 11 11 11 11 11 10 10 8 10 10 10 10 10 10 10 10 10 10 10 10 10 11 10 10 1 1 1 1 1 1 0 0 0 0 0 0 0 0 50 50 51 51 52 50 52 51 53 52 50 52 52 53 47 41 47

10

10

10

10

8

FAMILY DAY CARE MONTHLY MEAL COUNT AND CLAIM FOR REIMBURSEMENT

230

10

10

10

10

8

PM Snack

217

1

Supper

7

Night Snack

0
48

Total

40

50

50

48

0

1090

186.56 259.26 466.89 912.71

9

8

7

6

5

4

3

2

1

30 11 11 11 10 11 11 11 11 11 11 11 11 11 11 10 11 11 11 11

29

28

27

26

25

24

23

22

21

20

19

18

17

16

15

14

13

12

11

10

11

11

(Sat)

(Sat)

(Sat)

(Sat)

Licensed Capacity:

Daily Attendance

(Sun)

(Sun)

(Sun)

(Sun)

(Sun)

Name of Provider: John Houston - Let It Shine Childcare

I certify that I have followed USDA portion requirements and meal pattern guidelines. I am only claiming reimbursement for meals served to: (a) enrolled children of migrant workers 15 years of age and under, (b) mentally or physically disabled persons, as defined by the State, enrolled in an institution or child care site serving a majority of persons 18 years of age and under or (c) to enrolled Family Day Care children twelve (12) years old an dunder if they qualify.

Also, to the best of my knowledge, this home is not participating in the Child and Adult Care Food Program under any other Sponsoring Organization. I further certify that the meals served and attendance reported on this claim are true and correct in all aspects. I understand that this information is being given in connection with the receipt of Federal Funds; the USDA and the Department of Education officials may, for cause, verify information, and the deliberate misrepresentation may subject me to prosecution under applicable State and Federal criminal statutes. Date__________________________________________________________

Signature of Provider:______________________________________________

229
10 10 12 8 8 9 9 5 9 9 7 7 7 7 9 6 8 8 7 8
Breakfast

7

8

166
11 11 11 10 11 11 11 11 11 11 11 11 11 11 10 11 11 11 11
AM Snack Lunch

11

11

Month and Year: April 2007

229
11 11 11 10 11 11 11 11 11 11 11 11 11 11 10 11 11 11 11 9 10 10 10 10 10 10 10 10 11 11 10 10 10 10 10 10 10 10 2 0 0 0 0 0 0 51 51 52 48 50 52 52 50 50 51 54 53 50 52 46 51 51 50 51

11

11

FAMILY DAY CARE MONTHLY MEAL COUNT AND CLAIM FOR REIMBURSEMENT

229

10

10

PM Snack

211

2

Supper

4

Night Snack

0
0

Total

50

53

0

0

0

1068

175.96 255.2 459.01 890.17

9

8

7

6

5

4

3

2

1

31 8 8 7 9 9 2 2 11 11 11 11 11 11 11 11 11 11 11 11 11 11 (Sat) (Sat) (Sat)
Daily Attendance

30

29

28

27

26

25

24

23

22

21

20

19

18

17

16

15

14

13

12

11

10

12 10 10 12 6 6 5 5 5 9 9 9 9 7 7 7 7 7 8 8 7
Breakfast

10

11

Licensed Capacity:

(Sun)

(Sun)

(Sun)

Closed - Memorial Day

Name of Provider: John Houston - Let It Shine Childcare

I certify that I have followed USDA portion requirements and meal pattern guidelines. I am only claiming reimbursement for meals served to: (a) enrolled children of migrant workers 15 years of age and under, (b) mentally or physically disabled persons, as defined by the State, enrolled in an institution or child care site serving a majority of persons 18 years of age and under or (c) to enrolled Family Day Care children twelve (12) years old an dunder if they qualify.

Also, to the best of my knowledge, this home is not participating in the Child and Adult Care Food Program under any other Sponsoring Organization. I further certify that the meals served and attendance reported on this claim are true and correct in all aspects. I understand that this information is being given in connection with the receipt of Federal Funds; the USDA and the Department of Education officials may, for cause, verify information, and the deliberate misrepresentation may subject me to prosecution under applicable State and Federal criminal statutes. Date__________________________________________________________

Signature of Provider:______________________________________________

232
8 8 7 9 9 2 2 11 11 11 11 11 11 11 11 11 11 11 11 11 11
AM Snack

8 8 8 7 9 9 2 2 11 11 11 11 11 11 11 11 11 11 11 11 11 11 8 8 7 9 9 2 2 10 10 10 10 10 10 10 10 10 10 10 10 10 10 2 2 0 0 0 0 0 38 38 33 41 41 52 52 52 52 50 10 10 50 53 53 50 50 50 51 51 50

6

7

162
Lunch PM Snack Supper Night Snack Total

12

10

11

Month and Year: May 2007

232

12

10

11

FAMILY DAY CARE MONTHLY MEAL COUNT AND CLAIM FOR REIMBURSEMENT

232

12

10

11

218

4

0

0

0

56

46

51

1080

171.72 261 464.92 897.64

9

8

7

6

5

4

3

2

1

30 11 11 12 12 11 12 12 12 12 11 12 12 12 12 12 12 12 12

29

28

27

26

25

24

23

22

21

20

19

18

17

16

15

14

13

12

11

10

12

11

10

Licensed Capacity:

Daily Attendance

(Sun)

(Sun)

(Sun)

(Sun)

(Sat)

(Sat)

(Sat)

(Sat)

(Sat)

Name of Provider: John Houston - Let It Shine Childcare

I certify that I have followed USDA portion requirements and meal pattern guidelines. I am only claiming reimbursement for meals served to: (a) enrolled children of migrant workers 15 years of age and under, (b) mentally or physically disabled persons, as defined by the State, enrolled in an institution or child care site serving a majority of persons 18 years of age and under or (c) to enrolled Family Day Care children twelve (12) years old an dunder if they qualify.

Also, to the best of my knowledge, this home is not participating in the Child and Adult Care Food Program under any other Sponsoring Organization. I further certify that the meals served and attendance reported on this claim are true and correct in all aspects. I understand that this information is being given in connection with the receipt of Federal Funds; the USDA and the Department of Education officials may, for cause, verify information, and the deliberate misrepresentation may subject me to prosecution under applicable State and Federal criminal statutes. Date__________________________________________________________

Signature of Provider:______________________________________________

245
11 11 11 11 12 7 7 9 8 7 8 8 8 7 9 9 9 9 9
Breakfast

8

7

6

179
11 11 12 12 11 12 12 12 12 11 12 12 12 12 12 12 12 12
AM Snack Lunch

12

11

10

Month and Year: June 2007

245
11 11 12 12 11 12 12 12 12 11 12 12 12 12 12 12 12 12 11 11 12 12 11 12 12 12 12 11 12 12 12 12 12 12 12 12 0 0 0 0 0 0 0 0 51 51 57 56 51 56 56 56 55 53 59 59 59 57 57 57 57 59

12

11

10

FAMILY DAY CARE MONTHLY MEAL COUNT AND CLAIM FOR REIMBURSEMENT

245

12

11

10

PM Snack

245

Supper

0

Night Snack

0

Total

56

51

46

0

0

1159

189.74 284.2 482.65 956.59

9

8

7

6

5

4

3

2

1

31 12 14 14 14 14 14 13 12 12 14 14 13 14 14 14 14 (Sat) (Sat) (Sat)
Daily Attendance

30

29

28

27

26

25

24

23

22

21

20

19

18

17

16

15

14

13

12

11

10

13 8 9 7 10 10 11 10 10 10 11 12 10 12 12 11 11 12
Breakfast

13

14

(Sat)

Licensed Capacity:

Closed

Closed

Closed

(Sun)

(Sun)

(Sun)

(Sun)

(Sun)

Name of Provider: John Houston - Let It Shine Childcare

I certify that I have followed USDA portion requirements and meal pattern guidelines. I am only claiming reimbursement for meals served to: (a) enrolled children of migrant workers 15 years of age and under, (b) mentally or physically disabled persons, as defined by the State, enrolled in an institution or child care site serving a majority of persons 18 years of age and under or (c) to enrolled Family Day Care children twelve (12) years old an dunder if they qualify.

Also, to the best of my knowledge, this home is not participating in the Child and Adult Care Food Program under any other Sponsoring Organization. I further certify that the meals served and attendance reported on this claim are true and correct in all aspects. I understand that this information is being given in connection with the receipt of Federal Funds; the USDA and the Department of Education officials may, for cause, verify information, and the deliberate misrepresentation may subject me to prosecution under applicable State and Federal criminal statutes. Date__________________________________________________________

Signature of Provider:______________________________________________

256
12 13 14 14 14 14 13 12 12 14 14 13 14 14 14 14
AM Snack Lunch

11 12 13 14 14 14 14 13 12 12 14 14 13 14 14 14 14 12 13 14 14 14 14 13 12 12 14 14 13 14 14 14 14
PM Snack Supper Night Snack

11

11

197
0 0 0 0 0 0 0 0 0 0
Total

13 56 62 66 66 67 66 62 55 58 67 68 62 68 68 67 67

13

14

Month and Year: July 2007

255

13

13

14

FAMILY DAY CARE MONTHLY MEAL COUNT AND CLAIM FOR REIMBURSEMENT

255

13

13

14

255

0

0

0

0

63

63

67

1218

208.82 295.8 502.35 1006.97

9

8

7

6

5

4

3

2

1

Licensed Capacity:

Name of Provider: John Houston - Let It Shine Childcare

I certify that I have followed USDA portion requirements and meal pattern guidelines. I am only claiming reimbursement for meals served to: (a) enrolled children of migrant workers 15 years of age and under, (b) mentally or physically disabled persons, as defined by the State, enrolled in an institution or child care site serving a majority of persons 18 years of age and under or (c) to enrolled Family Day Care children twelve (12) years old an dunder if they qualify.

Also, to the best of my knowledge, this home is not participating in the Child and Adult Care Food Program under any other Sponsoring Organization. I further certify that the meals served and attendance reported on this claim are true and correct in all aspects. I understand that this information is being given in connection with the receipt of Federal Funds; the USDA and the Department of Education officials may, for cause, verify information, and the deliberate misrepresentation may subject me to prosecution under applicable State and Federal criminal statutes. Date__________________________________________________________

Signature of Provider:______________________________________________

31 10 10 10 13 14 14 13 14 14 14 14 14 8 9 9 9 9 9 (Sat) (Sat) (Sat) (Sat)
Daily Attendance

30 (Sun) (Sun) (Sun) (Sun)
Breakfast

29 12 13 12 11 13 13 13 13 13 12 6 7 7 7 7 8 8 9 6
AM Snack

28

27

26

25

24

23

22

21

20

19

18

17

16

15

14

13

12

11

10

8 10 10 10 13 14 14 13 14 14 14 14 14 8 9 9 9 9 9
Lunch

9 10 10 10 13 14 14 13 14 14 14 14 14 8 9 9 9 9 9 Month and Year: August 2007
PM Snack

9 10 10 10 13 14 14 13 14 14 14 14 14 8 9 9 9 9 9
Supper Night Snack

9

9

6 0 0 0 0 0 0 0 0
Total

7 38 43 43 43 43 44 48 49 46 64 69 68 63 69 69 69 69 69

8

7

7

8

9

9

9

9

FAMILY DAY CARE MONTHLY MEAL COUNT AND CLAIM FOR REIMBURSEMENT

8

9

9

9

9

8

9

9

9

9

38

43

44

43

43

251 213

225.78 291.16 494.47 1011.41

I certify that I have followe and under, (b) mentally or Family Day Care children Also, to the best of my kn attendance reported on th Education officials may, fo Signature of Provider:___

251 251 251 0 0 1217

9

8

7

6

5

4

3

2

1

30 9 8 9 9 9 8 9 9 9 11 11 11 11 11 11 11 11

29

28

27

26

25

24

23

22

21

20

19

18

17

16

15

14

13

12

11

10

10

11

(Sat)

(Sat)

(Sat)

(Sat)

(Sat)

Licensed Capacity:

Daily Attendance

Closed

(Sun)

(Sun)

(Sun)

(Sun)

(Sun)

Name of Provider: John Houston - Let It Shine Childcare

I certify that I have followed USDA portion requirements and meal pattern guidelines. I am only claiming reimbursement for meals served to: (a) enrolled children of migrant workers 15 years of age and under, (b) mentally or physically disabled persons, as defined by the State, enrolled in an institution or child care site serving a majority of persons 18 years of age and under or (c) to enrolled Family Day Care children twelve (12) years old an dunder if they qualify.

Also, to the best of my knowledge, this home is not participating in the Child and Adult Care Food Program under any other Sponsoring Organization. I further certify that the meals served and attendance reported on this claim are true and correct in all aspects. I understand that this information is being given in connection with the receipt of Federal Funds; the USDA and the Department of Education officials may, for cause, verify information, and the deliberate misrepresentation may subject me to prosecution under applicable State and Federal criminal statutes. Date__________________________________________________________

Signature of Provider:______________________________________________

188
12 5 5 6 8 5 7 5 5 7 4 7 7 7 6 7 7 7
Breakfast

6

5

116
9 9 9 9 9 9 9 9 9 8 9 9 9 8 9 9 9
AM Snack Lunch

8

9

Month and Year:

168
9 9 9 9 9 9 9 9 9 8 9 9 9 8 9 9 9 9 8 9 9 9 8 9 9 9 11 11 11 11 11 11 11 11 2 0 0 0 0 0 0 0 0 45 45 48 48 45 47 45 45 43 36 43 43 43 38 43 43 43

8

9

FAMILY DAY CARE MONTHLY MEAL COUNT AND CLAIM FOR REIMBURSEMENT

168

10

11

PM Snack

Sep-07

188

2

Supper

4

Night Snack

0
0

Total

42

47

0

0

0

832

122.96 206.48 338.84 668.28

9

8

7

6

5

4

3

2

1

31 12 12 11 12 12 11 11 11 11 11 11 11 11 11 11 10 11 11 11 11 (Sat) (Sat) (Sat)
Daily Attendance

30

29

28

27

26

25

24

23

22

21

20

19

18

17

16

15

14

13

12

11

10

10 5 4 8 7 5 6 6 5 7 7 7 7 7 8 4 5 5 7 7 11 12
Breakfast

12

12

(Sat)

Licensed Capacity:

(Sun)

(Sun)

(Sun)

(Sun)

Name of Provider: John Houston - Let It Shine Childcare

I certify that I have followed USDA portion requirements and meal pattern guidelines. I am only claiming reimbursement for meals served to: (a) enrolled children of migrant workers 15 years of age and under, (b) mentally or physically disabled persons, as defined by the State, enrolled in an institution or child care site serving a majority of persons 18 years of age and under or (c) to enrolled Family Day Care children twelve (12) years old an dunder if they qualify.

Also, to the best of my knowledge, this home is not participating in the Child and Adult Care Food Program under any other Sponsoring Organization. I further certify that the meals served and attendance reported on this claim are true and correct in all aspects. I understand that this information is being given in connection with the receipt of Federal Funds; the USDA and the Department of Education officials may, for cause, verify information, and the deliberate misrepresentation may subject me to prosecution under applicable State and Federal criminal statutes. Date__________________________________________________________

Signature of Provider:______________________________________________

257
9 8 9 9 9 9 9 9 8 9 9 9 9 12 10 11 10 10 11 10
AM Snack

12

4 9 8 9 9 9 9 9 9 8 9 9 9 9
Lunch

6

150
12 10 11 10 10 11 10 12 12 11 12 12 10 11 10 12 11 11 11 11 11 11 10 11 11 11 11
PM Snack

10

12

8 3 0 0 0 0 0 0 59 49 44 54 51 46 50 43 51 47 47 47 47 47 48 40 45 45 47

Month and Year: October 2007

219

10

12

8

FAMILY DAY CARE MONTHLY MEAL COUNT AND CLAIM FOR REIMBURSEMENT

219

10

12

12

256

Supper

3

Night Snack

0
47

0

0

Total

40

50

60

1104

159 275.5 437.34 871.84

9

8

7

6

5

4

3

2

1

30 6 8 11 11 11 11 12 11 11 12 11 13 12 10 11

29

28

27

26

25

24

23

22

21

20

19

18

17

16

15

14

13

12

11

10

13

13

13

14

(Sat)

(Sat)

(Sat)

(Sat)

Licensed Capacity:

Daily Attendance

Closed

Closed

Closed

(Sun)

(Sun)

(Sun)

(Sun)

Name of Provider: John Houston - Let It Shine Childcare

I certify that I have followed USDA portion requirements and meal pattern guidelines. I am only claiming reimbursement for meals served to: (a) enrolled children of migrant workers 15 years of age and under, (b) mentally or physically disabled persons, as defined by the State, enrolled in an institution or child care site serving a majority of persons 18 years of age and under or (c) to enrolled Family Day Care children twelve (12) years old an dunder if they qualify.

Also, to the best of my knowledge, this home is not participating in the Child and Adult Care Food Program under any other Sponsoring Organization. I further certify that the meals served and attendance reported on this claim are true and correct in all aspects. I understand that this information is being given in connection with the receipt of Federal Funds; the USDA and the Department of Education officials may, for cause, verify information, and the deliberate misrepresentation may subject me to prosecution under applicable State and Federal criminal statutes. Date__________________________________________________________

Signature of Provider:______________________________________________

214
12 7 6 6 5 5 7 7 8 5 6 6 7 6 5 5
Breakfast

7

7

7

9

121
9 6 6 9 9 9 9 9 9 8 9 10 10 11 10
AM Snack

11

11

11

12

Month and Year:

178
9 6 6 9 9 9 9 9 9 8 9 10 10 11 10 6 8 11 11 11 11 12 11 11 12 11 13 12 10 11 0 0 0 0 0 0 0 0 0 0 0 47 30 34 45 45 47 51 48 45 50 46 55 50 41 45

Lunch

11

11

11

12

FAMILY DAY CARE MONTHLY MEAL COUNT AND CLAIM FOR REIMBURSEMENT

178

13

13

13

14

PM Snack

Nov-07

214

Supper

0

Night Snack

0

Total

55

55

55

61

0

905

128.26 227.36 350.66 706.28

FAMILY DAY CARE MONTHLY MEAL COUNT AND CLAIM FOR REIMBURSEMENT
I certify that I have followed USDA portion requirements and meal pattern guidelines. I am only claiming reimbursement for meals served to: (a) enrolled children of migrant workers 15 years of age and under, (b) mentally or physically disabled persons, as defined by the State, enrolled in an institution or child care site serving a majority of persons 18 years of age and under or (c) to enrolled Family Day Care children twelve (12) years old an dunder if they qualify.

Name of Provider: John Houston - Let It Shine Childcare Licensed Capacity:
Daily Attendance

12
Breakfast

Month and Year: December 2007
AM Snack Lunch PM Snack Supper Night Snack Total

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30

(Sat) (Sun) 13 13 12 13 13 (Sat) (Sun) 13 13 13 13 13 (Sat) (Sun) 13 13 13 13 12 (Sat) (Sun) Closed Closed Closed Closed Closed (Sat) (Sun) 10 10 9 9 8 11 12 11 11 10 11 12 11 11 10 13 13 13 13 12 10 10 7 7 7 11 12 11 11 11 11 12 11 11 11 13 13 13 13 13 7 8 9 6 7 11 12 10 11 11 11 12 10 11 11 13 13 12 13 13 4

0 0 55 58 53 54 59 0 0 58 60 55 55 55 0 0 58 60 57 57 52 0 0 0 0 0 0 0 0 0

31 Closed

193 124

131.44 208.22 334.9 674.56

I certify that I have followed USDA portion and under, (b) mentally or physically disabl Family Day Care children twelve (12) year

166 166 193 4 0
0

846

Also, to the best of my knowledge, this home is not participating in the Child and Adult Care Food Program under any other Sponsoring Organization. I further certify that the meals served and attendance reported on this claim are true and correct in all aspects. I understand that this information is being given in connection with the receipt of Federal Funds; the USDA and the Department of Education officials may, for cause, verify information, and the deliberate misrepresentation may subject me to prosecution under applicable State and Federal criminal statutes. Date__________________________________________________________

Signature of Provider:______________________________________________

Also, to the best of my knowledge, this ho attendance reported on this claim are true Education officials may, for cause, verify in Signature of Provider:________________