| Payment ID | 16396 |
|---|---|
| Date Created | 01/28/23 4:49 pm |
| Created By | Gloria Jimenez |
| Service Request | |
| Application ID | 14342 |
| Authorization Number | |
| Applicant Information | |
| Name | Candy Jones |
| Applicant Email Address | Email hidden; Javascript is required. |
| Unique Identifier | 16170601085 |
| Payment Type | Short-Term Hotel/Motel Stays |
| Payment Details | |
| Payment Amount | $89.00 |
| Receipt Amount | $89.00 |
| Receipt Date | 01/25/2023 |
| Comments | hotel stay departure date is 01/31/23 |
| Receipt | 25-01-2023Jones89.00.pdf |
| Staff Name | Gloria Jimenez |
| Case Manager | AL |
| Verifier Name | Gloria Jimenez |
| Verifier Signature | |
| Date Verified | 01/28/2023 |
