| Payment ID | 15197 |
|---|---|
| Date Created | 01/10/23 10:51 am |
| Created By | Gloria Jimenez |
| Service Request | |
| Application ID | 11868 |
| Authorization Number | |
| Applicant Information | |
| Name | gena colley |
| Applicant Email Address | Email hidden; Javascript is required. |
| Unique Identifier | 16170700931 |
| Payment Type | Short-Term Hotel/Motel Stays |
| Payment Details | |
| Bank Fees | No |
| Receipt Amount | $1,200.00 |
| Receipt Date | 01/09/2023 |
| Comments | hotel stay at Studio 6 departure date is 01/24/23 |
| Receipt | 09-01-2023colley1200.00.pdf |
| Staff Name | Gloria Jimenez |
| Case Manager | LRE |
| Verifier Name | Gloria Jimenez |
| Verifier Signature | |
| Date Verified | 01/10/2023 |
