Form Name:Landlord Statement FormInvestigator Name:Ken KauffmanClick here to view a sample form. HiddenInvestigator's Name:HiddenInvestigator's Title:INVESTIGATOR LUCAS COUNTY VETERANS SERVICESYour Full Name*Email Address* Phone*Preferred form of contact Email PhoneDigital Signature*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 applied* MM slash DD slash YYYY