Form Name:Food Voucher AuthorizationInvestigator Name:Michael PacakClick here to view a sample form. Your Full Name*Email Address* Phone*Preferred form of contact Email PhonePickup Authorization Type* Authorize a Pickup Person Pickup MyselfFood Voucher Pickup AuthorizationThis is to acknowledge that I have authorized the following person(s) to pick up my food vouchers from the Lucas County Veterans Service Commission on my behalf.Authorized person 01*Authorized person 02Click to Authorize* I acknowledge that by signing this form to authorize the above person(s), I am giving my permission to allow them to come to get my food vouchers for up to one year from the date of this signed form, or until I give written notification to change it.Digital Signature*Date* MM slash DD slash YYYY Decline Authorized Pick UpClick to Decline Authorized Pick Up Person* I decline the option to have any other person other than myself or my spouse (if applicable), to pick up my food vouchers from the Veterans Service Commission.Digital Signature*Date* MM slash DD slash YYYY
