| Payment ID | 11175 |
|---|---|
| Date Created | 11/07/22 12:57 pm |
| Created By | Gloria Jimenez |
| Service Request | |
| Application ID | 7272 |
| Authorization Number | |
| Applicant Information | |
| Name | Aric Hall |
| Applicant Email Address | Email hidden; Javascript is required. |
| Unique Identifier | 16170800603 |
| Payment Type | Short-Term Hotel/Motel Stays |
| Payment Details | |
| Receipt Amount | $700.13 |
| Receipt Date | 11/07/2022 |
| Comments | hotel extension at Studio 6 departure date is 11/14/2022 |
| Receipt | 07-11-2022-16170800603-Hall-700.13.pdf |
| Staff Name | Gloria Jimenez |
| Case Manager | LRE |
| Verifier Name | Gloria Jimenez |
| Verifier Signature | |
| Date Verified | 11/07/2022 |
