| Payment ID | 116033 |
|---|---|
| Date Created | 07/21/25 4:52 pm |
| Created By | Gloria Jimenez |
| Service Request | 115206 |
| Application ID | 6201 |
| Authorization Number | 226762 |
| Applicant Information | |
| Name | Jeremy Merenda |
| Applicant Email Address | Email hidden; Javascript is required. |
| Unique Identifier | 16171000549 |
| Payment Type | Homelessness |
| Type of Service Request | Homelessness |
| Payment Details | |
| Payment Amount | $250.00 |
| Receipt Amount | $80.58 |
| Receipt Date | 07/21/2025 |
| Comments | 3 pants, 3 black polo shirts, and pair of nonslip shoes. |
| Receipt | |
| Staff Name | Gloria Jimenez |
| Case Manager | LRE |
| Case Worker Email | Email hidden; Javascript is required. |
| Verifier Name | Gloria Jimenez |
| Verifier Signature | |
| Date Verified | 07/21/2025 |
