Cheque Receipt Acknowledgement Letter. Door Number and Street's Name, Area Name, City.You need to fill out a form to be considered for "Poor Person Relief. This modification allows us to send an acknowledgment receipt and copy of filed image. The sample acknowledgement letters for receipt of payment provided below can be used as format templates for official and personal purposes. If you are blind or seriously visually impaired and need this application in an alternative. If you choose No Fee, you must have submitted a No Fee Authorization Letter as one of your documents in order to complete the payment process. You don't need to fill out an Affidavit of Service if the person you serve signs and dates a copy of the OSC acknowledging that he or she received the papers. The applicant must fill out and submit the application form, along with supporting documents, to the Division of Youth. Apply to any SUNY college or university through one easy form.