| Payment ID | 12692 |
|---|---|
| Date Created | 11/29/22 8:05 pm |
| Created By | Gloria Jimenez |
| Service Request | |
| Application ID | 11604 |
| Authorization Number | |
| Applicant Information | |
| Name | Wayneisha Bennett |
| Applicant Email Address | Email hidden; Javascript is required. |
| Unique Identifier | 16170100913 |
| Payment Type | Short-Term Hotel/Motel Stays |
| Payment Details | |
| Receipt Amount | $2,491.99 |
| Receipt Date | 11/29/2022 |
| Comments | hotel stay at Super 8 departure date is 12/20/2022 |
| Receipt | 29-11-2022Bennett2491.99.pdf |
| Staff Name | Gloria Jimenez |
| Case Manager | DJ |
| Verifier Name | Gloria Jimenez |
| Verifier Signature | |
| Date Verified | 11/29/2022 |
