| Payment ID | 109690 |
|---|---|
| Date Created | 06/05/25 8:41 am |
| Created By | Gloria Jimenez |
| Service Request | 108245 |
| Application ID | 68070 |
| Authorization Number | 226105 |
| Applicant Information | |
| Name | Alysia Williams |
| Applicant Email Address | Email hidden; Javascript is required. |
| Unique Identifier | 16170503340 |
| Payment Type | Transportation |
| Type of Service Request | Transportation |
| Payment Details | |
| Payment Amount | $40.00 |
| Receipt Amount | $40.00 |
| Receipt Date | 06/04/2025 |
| Comments | leave at front desk @ Super 8 |
| Receipt | |
| Staff Name | Gloria Jimenez |
| Case Manager | LRE |
| Case Worker Email | Email hidden; Javascript is required. |
| Verifier Name | Gloria Jimenez |
| Verifier Signature | |
| Date Verified | 06/05/2025 |
