COUNTY OF KERN
OC Sills
PO BOX 511
BAKERSFIELD, CA 93302-0511
Date: 10/09/2021
Case Name: LA SHAWNDA O'BRIEN
Case Number: 1663121
Worker Name: Sheila R King
Worker ID: 15LS01300A
Worker Phone Number: (661) 631-6116
Customer ID:
VERIFICATION OF BENEFITS
LA SHAWNDA O'BRIEN
100 E CALIFORNIA AVE
BAKERSFIELD, CA 93307-1031
Physical Address:
Home Phone Number:
Monthly Benefits
MC
CMSP
10/20
Y
N
11/20
Y
N
12/20
Y
N
01/21
Y
N
02/21
Y
N
03/21
Y
N
04/21
Y
N
05/21
Y
N
06/21
Y
N
07/21
Y
N
08/21
Y
N
09/21
Y
N
10/21
Y
N
Month/Year
CalWORKs
GA/GR
CalFresh
RCA
Family Size
CSF 142 (10/2020)
Page 1 of 2
Current Household Details
Name
DOB
LA SHAWNDA O'BRIEN
02/10/1977
Aid In the
MC/CMSP
GA
OHC Medi-Cal CMSP
CalFresh CW
Code Home
SOC
/GR
30
Y
Y
Y
N
N
Y
N
0.00
Comments
CSF 142 (10/2020)
Page 2 of 2