| Payment ID | 13153 |
|---|---|
| Date Created | 12/06/22 10:51 am |
| Created By | Gloria Jimenez |
| Service Request | |
| Application ID | 10228 |
| Authorization Number | |
| Applicant Information | |
| Name | Shayla Sterling |
| Applicant Email Address | Email hidden; Javascript is required. |
| Unique Identifier | 16100849 |
| Payment Type | Short-Term Hotel/Motel Stays |
| Payment Details | |
| Receipt Amount | $874.55 |
| Receipt Date | 12/05/2022 |
| Comments | hotel stay at Woodsprings departure date is 12/12/2022 |
| Receipt | 05-12-2022Sterling874.55.pdf |
| Staff Name | Gloria Jimenez |
| Case Manager | DJ |
| Verifier Name | Gloria Jimenez |
| Verifier Signature | |
| Date Verified | 12/06/2022 |
