| Payment ID | 17129 |
|---|---|
| Date Created | 02/08/23 11:02 am |
| Created By | Gloria Jimenez |
| Service Request | |
| Application ID | 2764 |
| Authorization Number | |
| Applicant Information | |
| Name | Christal Sterling |
| Applicant Email Address | Email hidden; Javascript is required. |
| Unique Identifier | 16171100262 |
| Payment Type | Short-Term Hotel/Motel Stays |
| Payment Details | |
| Payment Amount | $676.86 |
| Receipt Amount | $676.86 |
| Receipt Date | 02/03/2023 |
| Comments | hotel extension stay at Woodsprings Suite departure date is 02/09/2023 |
| Receipt | |
| Staff Name | Gloria Jimenez |
| Case Manager | DG |
| Verifier Name | Gloria Jimenez |
| Verifier Signature | |
| Date Verified | 02/08/2023 |
