| Payment ID | 12104 |
|---|---|
| Date Created | 11/22/22 9:15 am |
| Created By | Gloria Jimenez |
| Service Request | |
| Application ID | 9425 |
| Authorization Number | |
| Applicant Information | |
| Name | Leonard Thompson |
| 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 | 16171100773 |
| Payment Type | Short-Term Hotel/Motel Stays |
| Payment Details | |
| Receipt Amount | -$1,376.61 |
| Receipt Date | 11/21/2022 |
| Comments | refund from Super 8 |
| Receipt | 21-11-2022Thompson-1376.61.pdf |
| Staff Name | Gloria Jimenez |
| Case Manager | AL |
| Verifier Name | Gloria Jimenez |
| Verifier Signature | |
| Date Verified | 11/22/2022 |
