| Payment ID | 43075 |
|---|---|
| Date Created | 10/25/23 12:09 pm |
| Created By | Gloria Jimenez |
| Service Request | 42789 |
| Application ID | 40039 |
| Authorization Number | 222778 |
| Applicant Information | |
| Name | James Graf |
| Applicant Email Address | Email hidden; Javascript is required. |
| Unique Identifier | 16164302389 |
| Payment Type | Transportation |
| Type of Service Request | Transportation |
| Payment Details | |
| Payment Amount | $40.00 |
| Receipt Amount | $40.00 |
| Receipt Date | 10/24/2023 |
| Comments | bus pass |
| Receipt | 43075-Graf.pdf |
| Staff Name | Gloria |
| Case Manager | DJ |
| Case Worker Email | Email hidden; Javascript is required. |
| Verifier Name | Gloria Jimenez |
| Verifier Signature | |
| Date Verified | 10/25/2023 |
