| Payment ID | 18091 |
|---|---|
| Date Created | 02/22/23 11:28 am |
| Created By | Gloria Jimenez |
| Service Request | |
| Application ID | 8180 |
| Authorization Number | |
| Applicant Information | |
| Name | Anthony Davis |
| 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 | 16170800664 |
| Payment Type | Short-Term Hotel/Motel Stays |
| Payment Details | |
| Payment Amount | $476.43 |
| Receipt Amount | $476.43 |
| Receipt Date | 02/09/2023 |
| Comments | hotel stay at Woodspring departure date is 02/14/23 |
| Receipt | |
| Staff Name | Gloria Jimenez |
| Case Manager | BJ |
| Verifier Name | Gloria Jimenez |
| Verifier Signature | |
| Date Verified | 02/22/2023 |
