| Payment ID | 14221 |
|---|---|
| Date Created | 12/19/22 10:05 pm |
| Created By | Gloria Jimenez |
| Service Request | |
| Application ID | 9538 |
| Authorization Number | |
| Applicant Information | |
| Name | Adriana Gonzalez |
| Applicant Email Address | Email hidden; Javascript is required. |
| Unique Identifier | 16170600786 |
| Payment Type | Moving Fees |
| Payment Details | |
| Receipt Amount | $25.00 |
| Receipt Date | 12/19/2022 |
| Comments | moving fees to Salvation Army |
| Receipt | 19-12-2022Gonzalez25.00.pdf |
| Staff Name | Gloria Jimenez |
| Case Manager | AL |
| Verifier Name | Gloria Jimenez |
| Verifier Signature | |
| Date Verified | 12/19/2022 |
