| Payment ID | 17142 |
|---|---|
| Date Created | 02/08/23 11:09 am |
| Created By | Gloria Jimenez |
| Service Request | |
| Application ID | 9741 |
| Authorization Number | |
| Applicant Information | |
| Name | Ashley Joiner |
| Applicant Email Address | Email hidden; Javascript is required. |
| Unique Identifier | 16170500811 |
| Payment Type | Short-Term Hotel/Motel Stays |
| Payment Details | |
| Payment Amount | $196.65 |
| Receipt Amount | $196.65 |
| Receipt Date | 02/02/2023 |
| Comments | hotel extension at Woodspring departure date is 02/08/23 |
| Receipt | |
| Staff Name | Gloria Jimenez |
| Case Manager | DJ |
| Verifier Name | Gloria Jimenez |
| Verifier Signature | |
| Date Verified | 02/08/2023 |
