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P.O Box 2316
Southampton
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Dedicated to helping families and indivuals on the East End of Long Island for over 10 years
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Recipient Information
Recipient Name
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First Name
Last Name
Recipient Address
Address 1
Address 2
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Country
Applicant Information
Applicant Name
First Name
Last Name
Applicant Address
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Address 2
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Relation to Recipiant
Email
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Location
the recipient lives in...
Amagansett
Bridgehampton
East Hampton
East Quogue
Hampton Bays
Manorville
Montauk
Quogue
Remsenberg
Riverhead
Sag Harbor
Sagaponack
Southampton
Speonk
Water Mill
Westhampton
Westhampton Beach
Which Life Necessity Is Needed?
Food
Shelter
Heating
Clothing
Medical
Other*
*If Other Please Indicate Below
Thank you!