| Payment ID | 120455 |
|---|---|
| Date Created | 09/15/25 8:51 am |
| Created By | Gloria Jimenez |
| Service Request | 120073 |
| Application ID | 116878 |
| Authorization Number | 227037 |
| Applicant Information | |
| Name | Catrina Conner |
| Applicant Email Address | Email hidden; Javascript is required. |
| Unique Identifier | 16171105529 |
| Payment Type | Transportation |
| Type of Service Request | Transportation |
| Payment Details | |
| Payment Amount | $40.00 |
| Receipt Amount | $40.00 |
| Receipt Date | 09/10/2025 |
| Comments | Delivered to Super 8 at off I35 nearby University Area. |
| Receipt | |
| Staff Name | Gloria Jimenez |
| Case Manager | DG |
| Case Worker Email | Email hidden; Javascript is required. |
| Verifier Name | Gloria Jimenez |
| Verifier Signature | |
| Date Verified | 09/15/2025 |
