| Payment ID | 86779 |
|---|---|
| Date Created | 01/13/25 2:13 pm |
| Created By | Gloria Jimenez |
| Service Request | 85792 |
| Application ID | 26228 |
| Authorization Number | 224597 |
| Applicant Information | |
| Name | Olivia Stabeno |
| Applicant Email Address | Email hidden; Javascript is required. |
| Unique Identifier | 16170601691 |
| Payment Type | Transportation |
| Type of Service Request | Transportation |
| Payment Details | |
| Payment Amount | $40.00 |
| Receipt Amount | $40.00 |
| Receipt Date | 01/13/2025 |
| Comments | Delivered bus pass to WHA office on Cobbs |
| Receipt | 86779-Stabeno.pdf |
| Staff Name | Gloria Jimenez |
| Case Manager | DJ |
| Case Worker Email | Email hidden; Javascript is required. |
| Verifier Name | Gloria Jimenez |
| Verifier Signature | |
| Date Verified | 01/13/2025 |
