| Payment ID | 10732 |
|---|---|
| Date Created | 11/01/22 9:42 am |
| Created By | Gloria Jimenez |
| Service Request | |
| Application ID | 3566 |
| Authorization Number | |
| Applicant Information | |
| Name | Patricia Jones |
| Applicant Email Address | Email hidden; Javascript is required. |
| Unique Identifier | 16170600340 |
| Payment Type | Short-Term Hotel/Motel Stays |
| Payment Details | |
| Receipt Amount | $623.00 |
| Receipt Date | 10/31/2022 |
| Comments | extended stay at Super 8 departure date is 11/07/2022 |
| Receipt | 10732-Jones.pdf |
| Staff Name | Gloria Jimenez |
| Case Manager | BJ |
| Verifier Name | Gloria Jimenez |
| Verifier Signature | |
| Date Verified | 11/01/2022 |
