| Payment ID | 17550 |
|---|---|
| Date Created | 02/14/23 2:57 pm |
| Created By | Gloria Jimenez |
| Service Request | |
| Application ID | 11868 |
| Authorization Number | |
| Applicant Information | |
| Name | gena colley |
| Applicant Email Address | Email hidden; Javascript is required. |
| Unique Identifier | 16170700931 |
| Payment Type | Short-Term Hotel/Motel Stays |
| Payment Details | |
| Payment Amount | $1,068.00 |
| Receipt Amount | $1,068.00 |
| Receipt Date | 02/08/2023 |
| Comments | hotel stay at Super 8 departure date is 02/13/23 |
| Receipt | 08-02-2023colley1068.00.pdf |
| Staff Name | Gloria Jimenez |
| Case Manager | LRE |
| Verifier Name | Gloria Jimenez |
| Verifier Signature | |
| Date Verified | 02/14/2023 |
