| Payment ID | 3929 |
|---|---|
| Date Created | 07/12/22 2:02 pm |
| Created By | Gloria Jimenez |
| Service Request | |
| Application ID | 2624 |
| Authorization Number | |
| Applicant Information | |
| Name | Victoria Chapa |
| Applicant Email Address | Email hidden; Javascript is required. |
| Unique Identifier | 16170100242 |
| Payment Type | Moving Fees |
| Payment Details | |
| Receipt Amount | $412.50 |
| Receipt Date | 07/11/2022 |
| Comments | Al's moving company 7/11/22 |
| Receipt | |
| Staff Name | Gloria Jimenez |
| Case Manager | AL |
| Verifier Name | Gloria Jimenez |
| Verifier Signature | |
| Date Verified | 07/12/2022 |
