| Payment ID | 81022 |
|---|---|
| Date Created | 12/10/24 3:03 pm |
| Created By | Gloria Jimenez |
| Service Request | 80640 |
| Application ID | 80559 |
| Authorization Number | 224399 |
| Applicant Information | |
| Name | Calix Harabedoff |
| Applicant Email Address | Email hidden; Javascript is required. |
| Unique Identifier | 16170103743 |
| Payment Type | Transportation |
| Type of Service Request | Transportation |
| Payment Details | |
| Payment Amount | $40.00 |
| Receipt Amount | $40.00 |
| Receipt Date | 12/10/2024 |
| Comments | Please deliver bus pass to The Cove located at 524 W Waco DR. Please leave with Elena or Shelby. |
| Receipt | 81022-Harabedoff.pdf |
| Staff Name | Gloria Jimenez |
| Case Manager | BJ |
| Case Worker Email | Email hidden; Javascript is required. |
| Verifier Name | Gloria Jimenez |
| Verifier Signature | |
| Date Verified | 12/10/2024 |
