| Payment ID | 11190 |
|---|---|
| Date Created | 11/07/22 1:21 pm |
| Created By | Gloria Jimenez |
| Service Request | |
| Application ID | 9209 |
| Authorization Number | |
| Applicant Information | |
| Name | Tommy Bandy |
| Agency Name | Veterans Administration |
| Agency Code | 220308 |
| Agency | Veterans Administration |
| Agency Email Address | Email hidden; Javascript is required. |
| Applicant Email Address | Email hidden; Javascript is required. |
| Unique Identifier | 16171100746 |
| Payment Type | Short-Term Hotel/Motel Stays |
| Payment Details | |
| Receipt Amount | $592.38 |
| Receipt Date | 11/07/2022 |
| Comments | hotel extension at super 8 departure date is 11/20/2022 |
| Receipt | 07-11-2022-16171100746-Bandy-592.38.pdf |
| Staff Name | Gloria Jimenez |
| Case Manager | AL |
| Verifier Name | Gloria Jimenez |
| Verifier Signature | |
| Date Verified | 11/07/2022 |
