| Payment ID | 118871 |
|---|---|
| Date Created | 08/25/25 9:47 am |
| Created By | Gloria Jimenez |
| Service Request | 118516 |
| Application ID | 111406 |
| Authorization Number | 226954 |
| Applicant Information | |
| Name | Jasmine Earl |
| Applicant Email Address | Email hidden; Javascript is required. |
| Unique Identifier | 16171205254 |
| Payment Type | Transportation |
| Type of Service Request | Transportation |
| Payment Details | |
| Payment Amount | $80.00 |
| Receipt Amount | $80.00 |
| Receipt Date | 08/22/2025 |
| Comments | bus pass delivered |
| Receipt | |
| Staff Name | Gloria Jimenez |
| Case Manager | DJ |
| Case Worker Email | Email hidden; Javascript is required. |
| Verifier Name | Gloria Jimenez |
| Verifier Signature | |
| Date Verified | 08/25/2025 |
