| Payment ID | 13866 |
|---|---|
| Date Created | 12/15/22 10:41 am |
| Created By | Gloria Jimenez |
| Service Request | |
| Application ID | 10003 |
| Authorization Number | |
| Applicant Information | |
| Name | Julian Quiros |
| Applicant Email Address | Email hidden; Javascript is required. |
| Unique Identifier | 16171200828 |
| Payment Type | Short-Term Hotel/Motel Stays |
| Payment Details | |
| Receipt Amount | $445.00 |
| Receipt Date | 12/14/2022 |
| Comments | hotel stay at Super 8 departure date is 12/19/22 |
| Receipt | 14-12-2022Quiros445.00.pdf |
| Staff Name | Gloria Jimenez |
| Case Manager | LRE |
| Verifier Name | Gloria Jimenez |
| Verifier Signature | |
| Date Verified | 12/15/2022 |
