| Payment ID | 107674 |
|---|---|
| Date Created | 05/25/25 2:34 pm |
| Created By | Gloria Jimenez |
| Service Request | 106834 |
| Application ID | 83352 |
| Authorization Number | 225965 |
| Applicant Information | |
| Name | Serrina Rivera |
| Applicant Email Address | Email hidden; Javascript is required. |
| Unique Identifier | 16171103938 |
| Payment Type | Transportation |
| Type of Service Request | Transportation |
| Payment Details | |
| Payment Amount | $40.00 |
| Receipt Amount | $40.00 |
| Receipt Date | 05/22/2025 |
| Comments | deliveedr bus pass to the Motel 6 Waco front desk for client pick up |
| Receipt | |
| Staff Name | Gloria Jimenez |
| Case Manager | DJ |
| Case Worker Email | Email hidden; Javascript is required. |
| Verifier Name | Gloria Jimenez |
| Verifier Signature | |
| Date Verified | 05/25/2025 |
