| Payment ID | 16487 |
|---|---|
| Date Created | 01/30/23 11:04 am |
| Created By | Gloria Jimenez |
| Service Request | |
| Application ID | 14203 |
| Authorization Number | |
| Applicant Information | |
| Name | Andrew Pendlton |
| Applicant Email Address | Email hidden; Javascript is required. |
| Unique Identifier | 16101081 |
| Payment Type | Transportation |
| Payment Details | |
| Payment Amount | $40.00 |
| Receipt Amount | $40.00 |
| Receipt Date | 01/26/2023 |
| Comments | bus pass |
| Receipt | 26-01-2023Pendlton40.00.pdf |
| Staff Name | Gloria Jimenez |
| Case Manager | BJ |
| Verifier Name | Gloria Jimenez |
| Verifier Signature | |
| Date Verified | 01/30/2023 |
