| Payment ID | 115741 |
|---|---|
| Date Created | 07/18/25 11:06 am |
| Created By | Gloria Jimenez |
| Service Request | 113115 |
| Application ID | 30987 |
| Authorization Number | 226560 |
| Applicant Information | |
| Name | Shatea Randolph |
| Applicant Email Address | Email hidden; Javascript is required. |
| Unique Identifier | 16170401960 |
| Payment Type | Transportation |
| Type of Service Request | Transportation |
| Payment Details | |
| Payment Amount | $40.00 |
| Receipt Amount | $40.00 |
| Receipt Date | 07/17/2025 |
| Comments | Delivered to wha |
| Receipt | |
| Staff Name | Gloria Jimenez |
| Case Manager | LRE |
| Case Worker Email | Email hidden; Javascript is required. |
| Verifier Name | Gloria Jimenez |
| Verifier Signature | |
| Date Verified | 07/18/2025 |
