| Payment ID | 14269 |
|---|---|
| Date Created | 12/20/22 10:23 am |
| Created By | Gloria Jimenez |
| Service Request | |
| Application ID | 10939 |
| Authorization Number | |
| Applicant Information | |
| Name | Denise Constant |
| Agency Name | Veterans Administration |
| Agency Code | 220308 |
| Agency | Veterans Administration |
| Agency Email Address | Email hidden; Javascript is required. |
| Applicant Email Address | Email hidden; Javascript is required. |
| Unique Identifier | 16171100880 |
| Payment Type | Short-Term Hotel/Motel Stays |
| Payment Details | |
| Receipt Amount | $1,004.28 |
| Receipt Date | 12/19/2022 |
| Comments | extended stay at Woodsprings departure date is 01/02/23 |
| Receipt | 19-12-2022Constant1004.28.pdf |
| Staff Name | Gloria Jimenez |
| Case Manager | DG |
| Verifier Name | Gloria Jimenez |
| Verifier Signature | |
| Date Verified | 12/20/2022 |
