| Payment ID | 17157 |
|---|---|
| Date Created | 02/08/23 11:37 am |
| Created By | Gloria Jimenez |
| Service Request | |
| Application ID | 14935 |
| Authorization Number | |
| Applicant Information | |
| Name | Alissha Jones |
| Applicant Email Address | Email hidden; Javascript is required. |
| Unique Identifier | 16170401128 |
| Payment Type | Short-Term Hotel/Motel Stays |
| Payment Details | |
| Payment Amount | $621.31 |
| Receipt Amount | $621.31 |
| Receipt Date | 02/03/2023 |
| Comments | hotel stay at Woodsprings Suites departure date is 02/11/2023 |
| Receipt | |
| Staff Name | Gloria Jimenez |
| Case Manager | LRE |
| Verifier Name | Gloria Jimenez |
| Verifier Signature | |
| Date Verified | 02/08/2023 |
