Certification staff complete Form FNS-135 when the client returns food stamps. Mark the stamps "cancelled" before sending them to Fiscal Division.
Order supplies from Fiscal Division, State Office, 411-E.
Original and two copies.
Certification staff send the original with the cancelled food stamps attached, to:
The certification office keeps the first copy of Form FNS-135 and gives the second copy to the client.
Fiscal Division sends the original of Form FNS-135 to USDA, FNS.
Certification staff never exchange food stamps. When the client returns improperly manufactured or mutilated foods stamps, certification staff send the client to the issuance office.
Keep the certification office copy for three years from completion and until all audits have been completed.
1. Participant — Enter the client's name, mailing address, and case number, if known. If the case number is not known, enter "unknown."
2. Name and Address of Local Certification Office or Coupon Issuer — Enter the name and address of the local certification office where the form is completed.
3.a. Reason for Return — Check the box showing why the stamps are returned.
Note: Certification staff never use the "overissuances (cashier error)" box. For overissuances because of cashier error, certification staff send the client to the issuance office.
3.b. Reason for Exchange — Leave blank.
4. New Series Received — Enter the value of new series stamps returned for exchange under each denomination. Example: If two $5 stamps are returned for exchange, enter $10 in the box under the $5 denomination.
5. Old Series Received — Leave blank.
6.a. New Series Issued as Exchange — Leave blank.
6.b. Loose New Series Remaining — Leave blank.
7. Number of Books Used in Exchange — Leave blank.
9. Signature of Person Returning/Exchanging Coupons — The client or his representative signs and dates the form.
10. Signature of Person Receiving/Exchanging Coupons — The local office employee receiving the stamps signs and dates the form.
11. Signature of Witness — The person witnessing the transaction signs and dates the form.