| Payment ID | 42091 |
|---|---|
| Date Created | 10/16/23 12:37 pm |
| Created By | Gloria Jimenez |
| Service Request | 41162 |
| Application ID | 35966 |
| Authorization Number | 222674 |
| Applicant Information | |
| Name | Kiesha Drake |
| Applicant Email Address | Email hidden; Javascript is required. |
| Unique Identifier | 16170802190 |
| Payment Type | Transportation |
| Type of Service Request | Transportation |
| Payment Details | |
| Payment Amount | $90.00 |
| Receipt Amount | $40.00 |
| Receipt Date | 10/12/2023 |
| Comments | bus pass paid |
| Receipt | 42091-Drake.pdf |
| Staff Name | Gloria |
| Case Manager | DJ |
| Case Worker Email | Email hidden; Javascript is required. |
| Verifier Name | Gloria Jimenez |
| Verifier Signature | |
| Date Verified | 10/16/2023 |
