| Payment ID | 3502 |
|---|---|
| Date Created | 07/05/22 3:26 pm |
| Created By | Gloria Jimenez |
| Service Request | |
| Application ID | 2329 |
| Authorization Number | |
| Applicant Information | |
| Name | Jeanne Mayer |
| Applicant Email Address | Email hidden; Javascript is required. |
| Unique Identifier | 16170200223 |
| Payment Type | Short-Term Hotel/Motel Stays |
| Payment Details | |
| Receipt Amount | $1,420.25 |
| Receipt Date | 07/05/2022 |
| Comments | Fairfield by Marriott hotel for a 2 week stay |
| Receipt | 05-07-2022Mayer0.00.pdf |
| Staff Name | Gloria Jimenez |
| Case Manager | AL |
| Verifier Name | Gloria Jimenez |
| Verifier Signature | |
| Date Verified | 07/05/2022 |
