| Payment ID | 15441 |
|---|---|
| Date Created | 01/12/23 10:49 am |
| Created By | Gloria Jimenez |
| Service Request | |
| Application ID | 11158 |
| Authorization Number | |
| Applicant Information | |
| Name | Yusimil Herrera |
| Applicant Email Address | Email hidden; Javascript is required. |
| Unique Identifier | 01870600887 |
| Payment Type | Short-Term Hotel/Motel Stays |
| Payment Details | |
| Payment Amount | $623.00 |
| Receipt Amount | $623.00 |
| Receipt Date | 01/10/2023 |
| Comments | Super 8 by Windham |
| Receipt | 10-01-2023Herrera623.00.pdf |
| Staff Name | Gloria Jimenez |
| Case Manager | DG |
| Verifier Name | Gloria Jimenez |
| Verifier Signature | |
| Date Verified | 01/12/2023 |
