| Payment ID | 15196 |
|---|---|
| Date Created | 01/10/23 10:46 am |
| Created By | Gloria Jimenez |
| Service Request | |
| Application ID | 6226 |
| Authorization Number | |
| Applicant Information | |
| Name | Sadrina Gardner |
| Applicant Email Address | Email hidden; Javascript is required. |
| Unique Identifier | 16170400557 |
| Payment Type | Short-Term Hotel/Motel Stays |
| Payment Details | |
| Receipt Amount | $421.00 |
| Receipt Date | 01/09/2023 |
| Comments | hotel extension at Woodsprings departure date is 01/16/23 |
| Receipt | 09-01-2023Gardner421.00.pdf |
| Staff Name | Gloria Jimenez |
| Case Manager | LRE |
| Verifier Name | Gloria Jimenez |
| Verifier Signature | |
| Date Verified | 01/10/2023 |
