| Payment ID | 10740 |
|---|---|
| Date Created | 11/01/22 9:57 am |
| Created By | Gloria Jimenez |
| Service Request | |
| Application ID | 7088 |
| Authorization Number | |
| Applicant Information | |
| Name | Jynishia Degrate |
| Applicant Email Address | Email hidden; Javascript is required. |
| Unique Identifier | 16170400593 |
| Payment Type | Short-Term Hotel/Motel Stays |
| Payment Details | |
| Receipt Amount | $949.50 |
| Receipt Date | 10/31/2022 |
| Comments | hotel stay at Woodsprings arrival date is 10/24/2022 departure date is 11/08/2022 |
| Receipt | 10740-Degrate.pdf |
| Staff Name | Gloria Jimenez |
| Case Manager | DG |
| Verifier Name | Gloria Jimenez |
| Verifier Signature | |
| Date Verified | 11/01/2022 |
