| Payment ID | 103999 |
|---|---|
| Date Created | 04/28/25 9:34 am |
| Created By | Gloria Jimenez |
| Service Request | 99682 |
| Application ID | 97819 |
| Authorization Number | 225598 |
| Applicant Information | |
| Name | Steven Spears |
| Applicant Email Address | Email hidden; Javascript is required. |
| Unique Identifier | 16170604726 |
| Payment Type | Transportation |
| Type of Service Request | Transportation |
| Payment Details | |
| Payment Amount | $40.00 |
| Receipt Amount | $40.00 |
| Receipt Date | 04/24/2025 |
| Comments | delivered to front desk at Super 8. |
| Receipt | |
| Staff Name | Gloria Jimenez |
| Case Manager | DG |
| Case Worker Email | Email hidden; Javascript is required. |
| Verifier Name | Gloria Jimenez |
| Verifier Signature | |
| Date Verified | 04/28/2025 |
