| Payment ID | 10661 |
|---|---|
| Date Created | 10/31/22 9:35 am |
| Created By | Gloria Jimenez |
| Service Request | |
| Application ID | 6490 |
| Authorization Number | |
| Applicant Information | |
| Name | Jeffery Monroe |
| Applicant Email Address | Email hidden; Javascript is required. |
| Unique Identifier | 16170600575 |
| Payment Type | Short-Term Hotel/Motel Stays |
| Payment Details | |
| Receipt Amount | $619.99 |
| Receipt Date | 10/27/2022 |
| Comments | hotel paid to American Best departure date is 10/31/2022 |
| Receipt | 10661-Monroe.pdf |
| Staff Name | Gloria Jimenez |
| Case Manager | DJ |
| Verifier Name | Gloria Jimenez |
| Verifier Signature | |
| Date Verified | 10/31/2022 |
