| Payment ID | 69850 |
|---|---|
| Date Created | 06/25/24 2:34 pm |
| Created By | Gloria Jimenez |
| Service Request | 69378 |
| Application ID | 40252 |
| Authorization Number | 223990 |
| Applicant Information | |
| Name | La'jordan Easley |
| Applicant Email Address | Email hidden; Javascript is required. |
| Unique Identifier | 16171202407 |
| Payment Type | Transportation |
| Type of Service Request | Transportation |
| Payment Details | |
| Payment Amount | $40.00 |
| Receipt Amount | $40.00 |
| Receipt Date | 06/25/2024 |
| Comments | delivered to WHA for client |
| Receipt | 69850-Easley.pdf |
| Staff Name | Gloria |
| Case Manager | LRE |
| Case Worker Email | Email hidden; Javascript is required. |
| Verifier Name | Gloria Jimenez |
| Verifier Signature | |
| Date Verified | 06/25/2024 |
