Form Name:

Landlord Statement Form

Investigator Name:

Jana Oyerbides

Click here to view a sample form.

  • My digital signature means that I give the undersigned property owner (or his lawful agent) permission to furnish all information about me that is requested on this form. I understand that this information will be used to establish my eligibility for financial assistance. I also give the Lucas County Veterans Service Commission permission to contact the owner of the property (or lawful agent) where I live to obtain or clarify any information contained on this form.
  • Date Format: MM slash DD slash YYYY