In order for our office to begin your casework issue, we must have received a signed letter with the information below. Complete this information and either mail or fax it to the Canadian County office, listed at the bottom of this page.

Date ___________________

Social Security No. __________________

VA Claim No. ___________________

Date of Birth ___________________

Dear Congressman Lucas

I request your assistance in resolving the problem I am having with

Provide agency name
Give highlights, necessary dates and locations
(Use second sheet if necessary.)

In keeping with the restrictions of the Privacy Act, you are authorized to request any information required to assist me.

Your signature
Your full and complete name (Printed)
Address
Telephone(s)