| Payment ID | 98669 |
|---|---|
| Date Created | 03/24/25 4:43 pm |
| Created By | Gloria Jimenez |
| Service Request | 97728 |
| Application ID | 90467 |
| Authorization Number | 225451 |
| Applicant Information | |
| Name | Carlos Rodriguez |
| Agency Name | Veterans Administration |
| Agency Code | 220308 |
| Agency | Veterans Administration |
| Agency Email Address | Email hidden; Javascript is required. |
| Applicant Email Address | Email hidden; Javascript is required. |
| Unique Identifier | 16171104409 |
| Payment Type | Transportation |
| Type of Service Request | Transportation |
| Payment Details | |
| Payment Amount | $40.00 |
| Receipt Amount | $40.00 |
| Receipt Date | 03/19/2025 |
| Comments | delivered bus pass to the Delta Inn front desk for client pick up |
| Receipt | |
| Staff Name | Gloria Jimenez |
| Case Manager | DJ |
| Case Worker Email | Email hidden; Javascript is required. |
| Verifier Name | Gloria Jimenez |
| Verifier Signature | |
| Date Verified | 03/24/2025 |
