| Payment ID | 13127 |
|---|---|
| Date Created | 12/06/22 10:12 am |
| Created By | Gloria Jimenez |
| Service Request | |
| Application ID | 9561 |
| Authorization Number | |
| Applicant Information | |
| Name | Dorian Giles |
| Agency Name | ISD |
| Agency Code | 220501 |
| Agency | ISD |
| Agency Email Address | Email hidden; Javascript is required. |
| Applicant Email Address | Email hidden; Javascript is required. |
| Unique Identifier | 16170700789 |
| Payment Type | Short-Term Hotel/Motel Stays |
| Payment Details | |
| Receipt Amount | $623.00 |
| Receipt Date | 12/05/2022 |
| Comments | hotel stay at Super 8 room 1 departure date is 12/14/22 |
| Receipt | 05-12-2022Giles623.001.pdf |
| Staff Name | Gloria Jimenez |
| Case Manager | LRE |
| Verifier Name | Gloria Jimenez |
| Verifier Signature | |
| Date Verified | 12/06/2022 |
