| Payment ID | 3616 |
|---|---|
| Date Created | 07/06/22 4:30 pm |
| Created By | Gloria Jimenez |
| Service Request | |
| Application ID | 1062 |
| Authorization Number | |
| Applicant Information | |
| Name | Alfred Von Theumer |
| Applicant Email Address | Email hidden; Javascript is required. |
| Unique Identifier | 16170100134 |
| Payment Type | Homelessness |
| Payment Details | |
| Receipt Amount | $34.97 |
| Receipt Date | 06/17/2022 |
| Comments | bicycle helmets purchased |
| Staff Name | Gloria Jimenez |
| Case Manager | AL |
| Verifier Name | Gloria Jimenez |
| Verifier Signature | |
| Date Verified | 06/17/2022 |
