| Payment ID | 5556 |
|---|---|
| Date Created | 08/11/22 12:58 pm |
| Created By | Gloria Jimenez |
| Service Request | |
| Application ID | 4471 |
| Authorization Number | |
| Applicant Information | |
| Name | Jennifer Ramos |
| Applicant Email Address | Email hidden; Javascript is required. |
| Unique Identifier | 16170800421 |
| Payment Type | Moving Fees |
| Payment Details | |
| Receipt Amount | $825.00 |
| Receipt Date | 08/08/2022 |
| Comments | Al's moving fee. |
| Staff Name | Gloria Jimenez |
| Case Manager | DG |
| Verifier Name | Gloria Jimenez |
| Verifier Signature | |
| Date Verified | 08/11/2022 |
