| Payment ID | 3121 |
|---|---|
| Date Created | 06/27/22 2:48 pm |
| Created By | Gloria Jimenez |
| Service Request | |
| Application ID | 670 |
| Authorization Number | |
| Applicant Information | |
| Name | Johnathan Mitchell |
| Unique Identifier | 16170100101 |
| Payment Type | Homelessness |
| Payment Details | |
| Receipt Amount | $109.18 |
| Receipt Date | 05/26/2022 |
| Comments | Walmart shopping |
| Receipt | 3121-Mitchell.pdf |
| Staff Name | Gloria Jimenez |
| Case Manager | YS |
| Verifier Name | Gloria Jimenez |
| Verifier Signature | |
| Date Verified | 05/26/2022 |
