| Payment ID | 106666 |
|---|---|
| Date Created | 05/20/25 8:44 am |
| Created By | Gloria Jimenez |
| Service Request | 105930 |
| Application ID | 103730 |
| Authorization Number | 225922 |
| Applicant Information | |
| Name | Kenneth Tarver |
| Applicant Email Address | Email hidden; Javascript is required. |
| Unique Identifier | 16171004931 |
| Payment Type | Transportation |
| Type of Service Request | Transportation |
| Payment Details | |
| Payment Amount | $40.00 |
| Receipt Amount | $40.00 |
| Receipt Date | 05/19/2025 |
| Comments | deliver bus pass to the Delta Inn front desk |
| Receipt | |
| Staff Name | Gloria Jimenez |
| Case Manager | DJ |
| Case Worker Email | Email hidden; Javascript is required. |
| Verifier Name | Gloria Jimenez |
| Verifier Signature | |
| Date Verified | 05/20/2025 |
