| Payment ID | 17483 |
|---|---|
| Date Created | 02/13/23 4:56 pm |
| Created By | Gloria Jimenez |
| Service Request | |
| Application ID | 14464 |
| Authorization Number | |
| Applicant Information | |
| Name | Kasondra Redmon |
| Applicant Email Address | Email hidden; Javascript is required. |
| Unique Identifier | 16170601103 |
| Payment Type | Short-Term Hotel/Motel Stays |
| Payment Details | |
| Payment Amount | -$142.58 |
| Receipt Amount | -$142.58 |
| Receipt Date | 02/01/2023 |
| Comments | hotel refund from Motel 6 |
| Receipt | 01-02-2023Redmon-142.58.pdf |
| Staff Name | Gloria Jimenez |
| Case Manager | LRE |
| Verifier Name | Gloria Jimenez |
| Verifier Signature | |
| Date Verified | 02/13/2023 |
