| Payment ID | 16399 |
|---|---|
| Date Created | 01/28/23 5:30 pm |
| Created By | Gloria Jimenez |
| Service Request | |
| Application ID | 8819 |
| Authorization Number | |
| Applicant Information | |
| Name | Bennitra Cain |
| Agency Name | Veterans Administration |
| Agency Code | 220308 |
| Agency | Veterans Administration |
| Agency Email Address | Email hidden; Javascript is required. |
| Applicant Email Address | Email hidden; Javascript is required. |
| Unique Identifier | 16171100711 |
| Payment Type | Short-Term Hotel/Motel Stays |
| Payment Details | |
| Payment Amount | $801.00 |
| Receipt Amount | $801.00 |
| Receipt Date | 01/25/2023 |
| Comments | hotel stay at Super 8 departure date is 01/31/23 |
| Receipt | 25-01-2023Cain801.00.pdf |
| Staff Name | Gloria Jimenez |
| Case Manager | LRE |
| Verifier Name | Gloria Jimenez |
| Verifier Signature | |
| Date Verified | 01/28/2023 |
