| Payment ID | 110981 |
|---|---|
| Date Created | 06/16/25 4:09 pm |
| Created By | Gloria Jimenez |
| Service Request | 110628 |
| Application ID | 12420 |
| Authorization Number | 226349 |
| Applicant Information | |
| Name | Tyeshia Smith |
| Applicant Email Address | Email hidden; Javascript is required. |
| Unique Identifier | 16171200975 |
| Payment Type | Transportation |
| Type of Service Request | Transportation |
| Payment Details | |
| Payment Amount | $40.00 |
| Receipt Amount | $40.00 |
| Receipt Date | 06/16/2025 |
| Comments | delivered bus pass to Motel 6 front desk for client p/u |
| Receipt | |
| Staff Name | Gloria Jimenez |
| Case Manager | DJ |
| Case Worker Email | Email hidden; Javascript is required. |
| Verifier Name | Gloria Jimenez |
| Verifier Signature | |
| Date Verified | 06/16/2025 |
