| Payment ID | 29886 |
|---|---|
| Date Created | 06/20/23 12:21 pm |
| Created By | Gloria Jimenez |
| Service Request | 29104 |
| Application ID | 25440 |
| Authorization Number | 221955 |
| Applicant Information | |
| Name | Teretha Wooden |
| Applicant Email Address | Email hidden; Javascript is required. |
| Unique Identifier | 16170601647 |
| Payment Type | Transportation |
| Type of Service Request | Transportation |
| Payment Details | |
| Payment Amount | $90.00 |
| Receipt Amount | $40.00 |
| Receipt Date | 06/15/2023 |
| Comments | bus pass for 31 days |
| Receipt | 29886-Wooden.pdf |
| Staff Name | Gloria Jimenez |
| Case Manager | DJ |
| Case Worker Email | Email hidden; Javascript is required. |
| Verifier Name | Gloria Jimenez |
| Verifier Signature | |
| Date Verified | 06/20/2023 |
