| Payment ID | 17456 |
|---|---|
| Date Created | 02/13/23 2:21 pm |
| Created By | Gloria Jimenez |
| Service Request | |
| Application ID | 14906 |
| Authorization Number | |
| Applicant Information | |
| Name | Alyssa Lewis |
| Applicant Email Address | Email hidden; Javascript is required. |
| Unique Identifier | 16170601130 |
| Payment Type | Short-Term Hotel/Motel Stays |
| Payment Details | |
| Payment Amount | $578.37 |
| Receipt Amount | $578.37 |
| Receipt Date | 02/01/2023 |
| Comments | hotel extension at Motel 6 departure date is 02/09/2023 |
| Receipt | 01-02-2023Lewis578.37.pdf |
| Staff Name | Gloria Jimenez |
| Case Manager | LRE |
| Verifier Name | Gloria Jimenez |
| Verifier Signature | |
| Date Verified | 02/13/2023 |
