| Payment ID | 15736 |
|---|---|
| Date Created | 01/19/23 11:44 am |
| Created By | Gloria Jimenez |
| Service Request | |
| Application ID | 8782 |
| Authorization Number | |
| Applicant Information | |
| Name | David McDade |
| Applicant Email Address | Email hidden; Javascript is required. |
| Unique Identifier | 16171200707 |
| Payment Type | Short-Term Hotel/Motel Stays |
| Payment Details | |
| Payment Amount | $650.00 |
| Receipt Amount | $650.00 |
| Receipt Date | 01/17/2023 |
| Comments | hotel stay at Studio 6 paid for 01/12/23 through 01/19/23 |
| Receipt | 17-01-2023McDade650.00.pdf |
| Staff Name | Gloria Jimenez |
| Case Manager | AL |
| Verifier Name | Gloria Jimenez |
| Verifier Signature | |
| Date Verified | 01/19/2023 |
