| Payment ID | 17557 |
|---|---|
| Date Created | 02/14/23 3:17 pm |
| Created By | Gloria Jimenez |
| Service Request | |
| Application ID | 12917 |
| Authorization Number | |
| Applicant Information | |
| Name | Darrell Lewis-Crummer |
| 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 | 16170601011 |
| 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 extension at Super 8 departure date is 02/13/23 |
| Receipt | 08-02-2023Lewis-Crummer1068.00.pdf |
| Staff Name | Gloria Jimenez |
| Case Manager | AL |
| Verifier Name | Gloria Jimenez |
| Verifier Signature | |
| Date Verified | 02/14/2023 |
