| Payment ID | 13547 |
|---|---|
| Date Created | 12/12/22 10:17 am |
| Created By | Gloria Jimenez |
| Service Request | |
| Application ID | 9396 |
| Authorization Number | |
| Applicant Information | |
| Name | Christine Hedgecoke |
| Applicant Email Address | Email hidden; Javascript is required. |
| Unique Identifier | 16170800769 |
| Payment Type | Short-Term Hotel/Motel Stays |
| Payment Details | |
| Receipt Amount | $1,136.03 |
| Receipt Date | 12/09/2022 |
| Comments | hotel stay at Super 8 departure date is 12/20/22 |
| Receipt | 09-12-2022Hedgecoke1136.03.pdf |
| Staff Name | Gloria Jimenez |
| Case Manager | BJ |
| Verifier Name | Gloria Jimenez |
| Verifier Signature | |
| Date Verified | 12/12/2022 |
