Form Name:Acknowledgement of PaymentInvestigator Name:Jana OyerbidesClick here to view a sample form. Your Full Name*Email Address* Phone Number*Preferred Form of Contact Email PhoneLucas County Auditor's Warrant (Check) Number*Payment Amount*Payment to*Payment forCertify / Authorize*I understand that false statements made on this application may lead to prosecution. By checking this box, I certify that the information provided is correct to the best of my knowledge. I certify that the information provided is correct to the best of my knowledge.Digital Signature*Type your full nameDate MM slash DD slash YYYY
