| Payment ID | 3233 |
|---|---|
| Date Created | 06/28/22 2:11 pm |
| Created By | Gloria Jimenez |
| Service Request | |
| Application ID | 2624 |
| Authorization Number | |
| Applicant Information | |
| Name | Victoria Chapa |
| Unique Identifier | 16170100242 |
| Payment Type | Utility Deposits and Utility Reconnection Fees |
| Payment Details | |
| Receipt Amount | $395.00 |
| Receipt Date | 06/27/2022 |
| Comments | deposit paid by credit card to 4change energy. |
| Staff Name | Gloria Jimenez |
| Case Manager | AL |
| Verifier Name | Gloria Jimenez |
| Verifier Signature | |
| Date Verified | 06/27/2022 |
