| Payment ID | 1665 |
|---|---|
| Date Created | 06/07/22 12:20 pm |
| Created By | Gloria Jimenez |
| Service Request | |
| Application ID | 915 |
| Authorization Number | |
| Applicant Information | |
| Name | Schqina Williams |
| Unique Identifier | 11069200111 |
| Payment Type | Childcare Expenses |
| Payment Details | |
| Receipt Amount | $160.00 |
| Receipt Date | 06/07/2022 |
| Comments | funds made out to Tammy's Learning Center |
| Staff Name | Deborah Green |
| Staff Signature | |
| Verifier Name | Gloria JImenez |
| Verifier Signature | |
| Date Verified | 06/07/2022 |
