| Payment ID | 43758 |
|---|---|
| Date Created | 11/02/23 9:46 am |
| Created By | Gloria Jimenez |
| Service Request | 43478 |
| Application ID | 34777 |
| Authorization Number | 222825 |
| Applicant Information | |
| Name | Amanda Gonzales |
| Applicant Email Address | Email hidden; Javascript is required. |
| Unique Identifier | 16170502141 |
| Payment Type | Transportation |
| Type of Service Request | Transportation |
| Payment Details | |
| Payment Amount | $40.00 |
| Receipt Amount | $40.00 |
| Receipt Date | 11/02/2023 |
| Comments | bus pass |
| Receipt | 43758-Gonzales.pdf |
| Staff Name | Gloria |
| Case Manager | DL |
| Case Worker Email | Email hidden; Javascript is required. |
| Verifier Name | Gloria Jimenez |
| Verifier Signature | |
| Date Verified | 11/02/2023 |
