| Payment ID | 17156 |
|---|---|
| Date Created | 02/08/23 11:20 am |
| Created By | Gloria Jimenez |
| Service Request | |
| Application ID | 9366 |
| Authorization Number | |
| Applicant Information | |
| Name | Alton Robinson |
| 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 | 16170400764 |
| Payment Type | Short-Term Hotel/Motel Stays |
| Payment Details | |
| Payment Amount | $259.73 |
| Receipt Amount | $259.73 |
| Receipt Date | 02/03/2023 |
| Comments | hotel extension at Woodsprings Suite departure date is 02/07/2023 |
| Receipt | |
| Staff Name | Gloria Jimenez |
| Case Manager | DJ |
| Verifier Name | Gloria Jimenez |
| Verifier Signature | |
| Date Verified | 02/08/2023 |
