| Payment ID | 2897 |
|---|---|
| Date Created | 06/23/22 1:43 pm |
| Created By | Gloria Jimenez |
| Service Request | |
| Application ID | 376 |
| Authorization Number | |
| Applicant Information | |
| Name | Keysha McClendon |
| Unique Identifier | 16170500042 |
| Payment Type | Moving Fees |
| Payment Details | |
| Receipt Amount | $675.00 |
| Receipt Date | 06/17/2022 |
| Comments | moving fees to Al's moving company |
| Staff Name | Gloria Jimenez |
| Case Manager | GJ |
| Verifier Name | Gloria Jimenez |
| Verifier Signature | |
| Date Verified | 06/23/2022 |
