| Payment ID | 95356 |
|---|---|
| Date Created | 02/26/25 2:44 pm |
| Created By | Gloria Jimenez |
| Service Request | 92608 |
| Application ID | 73183 |
| Authorization Number | 225060 |
| Applicant Information | |
| Name | Rassoull Chase |
| Applicant Email Address | Email hidden; Javascript is required. |
| Unique Identifier | 16170403560 |
| Payment Type | Transportation |
| Type of Service Request | Transportation |
| Payment Details | |
| Payment Amount | $40.00 |
| Receipt Amount | $40.00 |
| Receipt Date | 02/21/2025 |
| Comments | bus pass delivered |
| Receipt | |
| Staff Name | Gloria Jimenez |
| Case Manager | DJ |
| Case Worker Email | Email hidden; Javascript is required. |
| Verifier Name | Gloria Jimenez |
| Verifier Signature | |
| Date Verified | 02/26/2025 |
