| Payment ID | 13475 |
|---|---|
| Date Created | 12/09/22 11:11 am |
| Created By | Gloria Jimenez |
| Service Request | |
| Application ID | 7272 |
| Authorization Number | |
| Applicant Information | |
| Name | Aric Hall |
| Applicant Email Address | Email hidden; Javascript is required. |
| Unique Identifier | 16170800603 |
| Payment Type | Short-Term Hotel/Motel Stays |
| Payment Details | |
| Receipt Amount | $681.38 |
| Receipt Date | 12/07/2022 |
| Comments | hotel stay at Super 8 departure date is 12/14/2022 |
| Receipt | 07-12-2022Hall681.38.pdf |
| Staff Name | Gloria Jimenez |
| Case Manager | LRE |
| Verifier Name | Gloria Jimenez |
| Verifier Signature | |
| Date Verified | 12/09/2022 |
