| Payment ID | 86784 |
|---|---|
| Date Created | 01/13/25 2:23 pm |
| Created By | Gloria Jimenez |
| Service Request | 86209 |
| Application ID | 83558 |
| Authorization Number | 224607 |
| Applicant Information | |
| Name | Qanisia Carroll |
| Applicant Email Address | Email hidden; Javascript is required. |
| Unique Identifier | 16170104019 |
| 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 the WHA office on Cobbs Dr for client pick up. |
| Receipt | 86784-Carroll.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 |
