| Payment ID | 10274 |
|---|---|
| Date Created | 10/25/22 4:31 pm |
| Created By | Gloria Jimenez |
| Service Request | |
| Application ID | 9561 |
| Authorization Number | |
| Applicant Information | |
| Name | Dorian Giles |
| Agency Name | ISD |
| Agency Code | 220501 |
| Agency | ISD |
| Agency Email Address | Email hidden; Javascript is required. |
| Applicant Email Address | Email hidden; Javascript is required. |
| Unique Identifier | 16170700789 |
| Payment Type | Short-Term Hotel/Motel Stays |
| Payment Details | |
| Receipt Amount | $948.38 |
| Receipt Date | 10/25/2022 |
| Comments | hotel stay at Super 8 arrival date 10/21/2022 departure 10/31/2022 one of 2 rooms, client has 6 children and needs 2 rooms. |
| Receipt | 10274-Giles.pdf |
| Staff Name | Gloria Jimenez |
| Case Manager | LRE |
| Verifier Name | Gloria Jimenez |
| Verifier Signature | |
| Date Verified | 10/25/2022 |
