| Payment ID | 14877 |
|---|---|
| Date Created | 01/04/23 12:21 pm |
| Created By | Gloria Jimenez |
| Service Request | |
| Application ID | 5727 |
| Authorization Number | |
| Applicant Information | |
| Name | Erika Smith |
| Applicant Email Address | Email hidden; Javascript is required. |
| Unique Identifier | 16170500532 |
| Payment Type | Short-Term Hotel/Motel Stays |
| Payment Details | |
| Receipt Amount | $378.98 |
| Receipt Date | 01/03/2023 |
| Comments | hotel stay paid to Woodspring suites |
| Receipt | 03-01-2023Smith378.98.pdf |
| Staff Name | Gloria Jimenez |
| Case Manager | BJ |
| Verifier Name | Gloria Jimenez |
| Verifier Signature | |
| Date Verified | 01/04/2023 |
