| Payment ID | 85945 |
|---|---|
| Date Created | 01/09/25 10:39 am |
| Created By | Gloria Jimenez |
| Service Request | 85188 |
| Application ID | 80762 |
| Authorization Number | 224554 |
| Applicant Information | |
| Name | Vance Simmons |
| Applicant Email Address | Email hidden; Javascript is required. |
| Unique Identifier | 16170503749 |
| Payment Type | Transportation |
| Type of Service Request | Transportation |
| Payment Details | |
| Payment Amount | $40.00 |
| Receipt Amount | $40.00 |
| Receipt Date | 01/07/2025 |
| Comments | bus pass delivered |
| Receipt | 85945-Simmons.pdf |
| Staff Name | Gloria Jimenez |
| Case Manager | BJ |
| Case Worker Email | Email hidden; Javascript is required. |
| Verifier Name | Gloria Jimenez |
| Verifier Signature | |
| Date Verified | 01/09/2025 |
