| Payment ID | 13143 |
|---|---|
| Date Created | 12/06/22 10:39 am |
| Created By | Gloria Jimenez |
| Service Request | |
| Application ID | 9209 |
| Authorization Number | |
| Applicant Information | |
| Name | Tommy Bandy |
| 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 | 16171100746 |
| Payment Type | Short-Term Hotel/Motel Stays |
| Payment Details | |
| Receipt Amount | $603.54 |
| Receipt Date | 12/05/2022 |
| Comments | hotel stay at Super 8 departure date is 12/14/22 |
| Receipt | 05-12-2022Bandy603.54.pdf |
| Staff Name | Gloria Jimenez |
| Case Manager | AL |
| Verifier Name | Gloria Jimenez |
| Verifier Signature | |
| Date Verified | 12/06/2022 |
