| Payment ID | 3081 |
|---|---|
| Date Created | 06/27/22 11:34 am |
| Created By | Gloria Jimenez |
| Service Request | |
| Application ID | 2523 |
| Authorization Number | |
| Applicant Information | |
| Name | Anthony Hazley |
| Agency Name | Housing Authorities |
| Agency Code | 220401 |
| Agency | Housing Authorities |
| Agency Email Address | Email hidden; Javascript is required. |
| Unique Identifier | 16170700229 |
| Payment Type | Short-Term Hotel/Motel Stays |
| Payment Details | |
| Receipt Amount | $2,413.00 |
| Receipt Date | 06/24/2022 |
| Comments | Super 8 hotel stay for 6/28/22 through 7/28/22 |
| Staff Name | Gloria Jimenez |
| Case Manager | DG |
| Verifier Name | Gloria Jimenez |
| Verifier Signature | |
| Date Verified | 06/24/2022 |
