| Payment ID | 3132 |
|---|---|
| Date Created | 06/27/22 3:57 pm |
| Created By | Gloria Jimenez |
| Service Request | |
| Application ID | 219 |
| Authorization Number | |
| Applicant Information | |
| Name | Nekiel Bennett |
| Unique Identifier | 16170700129 |
| Payment Type | Short-Term Hotel/Motel Stays |
| Payment Details | |
| Receipt Amount | $1,570.06 |
| Receipt Date | 06/09/2022 |
| Comments | Hotel stay at Woodsprings Suite 30-day stay |
| Staff Name | Gloria Jimenez |
| Case Manager | AL |
| Verifier Name | Gloria Jimenez |
| Verifier Signature | |
| Date Verified | 06/09/2022 |
