| Payment ID | 43292 |
|---|---|
| Date Created | 10/26/23 1:48 pm |
| Created By | Gloria Jimenez |
| Service Request | 43260 |
| Application ID | 42583 |
| Authorization Number | 222801 |
| Applicant Information | |
| Name | Alfred Santos-Perez |
| Agency Name | Homeless Coalition |
| Agency Code | 220213 |
| Agency | Homeless Coalition |
| Agency Email Address | Email hidden; Javascript is required. |
| Applicant Email Address | Email hidden; Javascript is required. |
| Unique Identifier | 16170102495 |
| Payment Type | Transportation |
| Type of Service Request | Transportation |
| Payment Details | |
| Payment Amount | $40.00 |
| Receipt Amount | $40.00 |
| Receipt Date | 10/26/2023 |
| Comments | bus pass |
| Receipt | 43292-Santos-Perez.pdf |
| Staff Name | Gloria |
| Case Manager | DG |
| Case Worker Email | Email hidden; Javascript is required. |
| Verifier Name | Gloria Jimenez |
| Verifier Signature | |
| Date Verified | 10/26/2023 |
