| Payment ID | 13064 |
|---|---|
| Date Created | 12/05/22 1:28 pm |
| Created By | Gloria Jimenez |
| Service Request | |
| Application ID | 11158 |
| Authorization Number | |
| Applicant Information | |
| Name | Yusimil Herrera |
| Applicant Email Address | Email hidden; Javascript is required. |
| Unique Identifier | 01870600887 |
| Payment Type | Short-Term Hotel/Motel Stays |
| Payment Details | |
| Receipt Amount | $1,974.59 |
| Receipt Date | 11/30/2022 |
| Comments | hotel stay at Super 8 departure date is 12/20/22 |
| Receipt | 30-11-2022Herrera1974.59.pdf |
| Staff Name | Gloria Jimenez |
| Case Manager | DG |
| Verifier Name | Gloria Jimenez |
| Verifier Signature | |
| Date Verified | 12/05/2022 |
