| Payment ID | 37405 |
|---|---|
| Date Created | 08/16/23 1:41 pm |
| Created By | Gloria Jimenez |
| Service Request | 36848 |
| Application ID | 34980 |
| Authorization Number | 222447 |
| Applicant Information | |
| Name | Azrian Emory |
| Applicant Email Address | Email hidden; Javascript is required. |
| Unique Identifier | 16171102147 |
| Payment Type | Transportation |
| Type of Service Request | Transportation |
| Payment Details | |
| Payment Amount | $80.00 |
| Receipt Amount | $40.00 |
| Receipt Date | 08/15/2023 |
| Comments | bus pass |
| Receipt | 37405-Emory.pdf |
| Staff Name | Gloria Jimenez |
| Case Manager | DG |
| Case Worker Email | Email hidden; Javascript is required. |
| Verifier Name | Gloria Jimenez |
| Verifier Signature | |
| Date Verified | 08/16/2023 |
