| Payment ID | 106962 |
|---|---|
| Date Created | 05/21/25 8:49 am |
| Created By | Gloria Jimenez |
| Service Request | 106541 |
| Application ID | 100773 |
| Authorization Number | 225960 |
| Applicant Information | |
| Name | Michal Lang |
| Applicant Email Address | Email hidden; Javascript is required. |
| Unique Identifier | 07466104847 |
| Payment Type | Transportation |
| Type of Service Request | Transportation |
| Payment Details | |
| Payment Amount | $40.00 |
| Receipt Amount | $40.00 |
| Receipt Date | 05/21/2025 |
| Comments | Delivered to Motel 6 |
| Receipt | |
| Staff Name | Gloria Jimenez |
| Case Manager | BP |
| Case Worker Email | Email hidden; Javascript is required. |
| Verifier Name | Gloria Jimenez |
| Verifier Signature | |
| Date Verified | 05/21/2025 |
