| Payment ID | 11991 |
|---|---|
| Date Created | 11/21/22 12:41 pm |
| Created By | Gloria Jimenez |
| Service Request | |
| Application ID | 3698 |
| Authorization Number | |
| Applicant Information | |
| Name | julia mahan |
| Applicant Email Address | Email hidden; Javascript is required. |
| Unique Identifier | 16171000342 |
| Payment Type | Short-Term Hotel/Motel Stays |
| Payment Details | |
| Receipt Amount | $399.00 |
| Receipt Date | 11/15/2022 |
| Comments | hotel extension at Woodspring |
| Receipt | 15-11-2022mahan399.00.pdf |
| Staff Name | Gloria Jimenez |
| Case Manager | BJ |
| Verifier Name | Gloria Jimenez |
| Verifier Signature | |
| Date Verified | 11/21/2022 |
