| Payment ID | 5372 |
|---|---|
| Date Created | 08/09/22 9:11 am |
| Created By | Gloria Jimenez |
| Service Request | |
| Application ID | 1050 |
| Authorization Number | |
| Applicant Information | |
| Name | Brandy Davis |
| Agency Name | ISD |
| Agency Code | 220501 |
| Agency | ISD |
| Agency Email Address | Email hidden; Javascript is required. |
| Applicant Email Address | Email hidden; Javascript is required. |
| Unique Identifier | 16170600126 |
| Payment Type | Moving Fees |
| Payment Details | |
| Receipt Amount | $675.00 |
| Receipt Date | 07/27/2022 |
| Comments | moving fees for Al's moving company |
| Receipt | 5372-Davis.HEIC |
| Staff Name | Gloria Jimenez |
| Case Manager | AL |
| Verifier Name | Gloria Jimenez |
| Verifier Signature | |
| Date Verified | 08/09/2022 |
