| Payment ID | 15096 |
|---|---|
| Date Created | 01/09/23 12:43 pm |
| Created By | Gloria Jimenez |
| Service Request | |
| Application ID | 3055 |
| Authorization Number | |
| Applicant Information | |
| Name | Jamaica Rhodes |
| Applicant Email Address | Email hidden; Javascript is required. |
| Unique Identifier | 16171000294 |
| Payment Type | Short-Term Hotel/Motel Stays |
| Payment Details | |
| Receipt Amount | $712.00 |
| Receipt Date | 01/03/2023 |
| Comments | hotel stay at Super 8 departure date is 01/10/23 |
| Receipt | 03-01-2023Rhodes712.00.pdf |
| Staff Name | Gloria Jimenez |
| Case Manager | DG |
| Verifier Name | Gloria Jimenez |
| Verifier Signature | |
| Date Verified | 01/09/2023 |
