| Payment ID | 15420 |
|---|---|
| Date Created | 01/12/23 9:39 am |
| Created By | Gloria Jimenez |
| Service Request | |
| Application ID | 13894 |
| Authorization Number | |
| Applicant Information | |
| Name | Jasmine Bates |
| Applicant Email Address | Email hidden; Javascript is required. |
| Unique Identifier | 16170601061 |
| Payment Type | Short-Term Hotel/Motel Stays |
| Payment Details | |
| Payment Amount | $1,116.71 |
| Bank Fees | No |
| Receipt Amount | $1,116.71 |
| Receipt Date | 01/10/2023 |
| Comments | hotel stay at Super 8 departure date is 01/17/23 |
| Receipt | 10-01-2023Bates1116.71.pdf |
| Staff Name | Gloria Jimenez |
| Case Manager | BJ |
| Verifier Name | Gloria Jimenez |
| Verifier Signature | |
| Date Verified | 01/12/2023 |
