| Payment ID | 8399 |
|---|---|
| Date Created | 09/20/22 10:34 am |
| Created By | Gloria Jimenez |
| Service Request | |
| Application ID | 1208 |
| Authorization Number | |
| Applicant Information | |
| Name | Ronnie White |
| Applicant Email Address | Email hidden; Javascript is required. |
| Unique Identifier | 16171200145 |
| Payment Type | Transportation |
| Payment Details | |
| Receipt Amount | $40.00 |
| Receipt Date | 09/15/2022 |
| Comments | bus pass bought on 9/15/22 |
| Receipt | 8399-White.pdf |
| Staff Name | Gloria Jimenez |
| Case Manager | AL |
| Verifier Name | Gloria Jimenez |
| Verifier Signature | |
| Date Verified | 09/20/2022 |
