| Payment ID | 13560 |
|---|---|
| Date Created | 12/12/22 12:07 pm |
| Created By | Gloria Jimenez |
| Service Request | |
| Application ID | 7549 |
| Authorization Number | |
| Applicant Information | |
| Name | Antoinette Guajardo |
| Applicant Email Address | Email hidden; Javascript is required. |
| Unique Identifier | 16171000615 |
| Payment Type | Short-Term Hotel/Motel Stays |
| Payment Details | |
| Receipt Amount | $729.91 |
| Receipt Date | 12/08/2022 |
| Comments | hotel stay at Super 8 departure date 12/15/22 |
| Receipt | 08-12-2022Guajardo729.91.pdf |
| Staff Name | Gloria Jimenez |
| Case Manager | DG |
| Verifier Name | Gloria Jimenez |
| Verifier Signature | |
| Date Verified | 12/12/2022 |
