| Payment ID | 70023 |
|---|---|
| Date Created | 06/26/24 1:29 pm |
| Created By | Gloria Jimenez |
| Service Request | 69807 |
| Application ID | 60994 |
| Authorization Number | 224023 |
| Applicant Information | |
| Name | Nathan Diss |
| Applicant Email Address | Email hidden; Javascript is required. |
| Unique Identifier | 16170503068 |
| Payment Type | Homelessness |
| Type of Service Request | Homelessness |
| Payment Details | |
| Payment Amount | $100.00 |
| Receipt Amount | $85.94 |
| Receipt Date | 06/26/2024 |
| Comments | Walmart receipt for homelessness |
| Receipt | 70023-Diss.pdf |
| Staff Name | Gloria |
| Case Manager | BJ |
| Case Worker Email | Email hidden; Javascript is required. |
| Verifier Name | Gloria Jimenez |
| Verifier Signature | |
| Date Verified | 06/26/2024 |
