| Payment ID | 3507 |
|---|---|
| Date Created | 07/05/22 3:40 pm |
| Created By | Gloria Jimenez |
| Service Request | |
| Application ID | 1780 |
| Authorization Number | |
| Applicant Information | |
| Name | Rebecca Mcbride |
| Applicant Email Address | Email hidden; Javascript is required. |
| Unique Identifier | 16170800195 |
| Payment Type | Short-Term Hotel/Motel Stays |
| Payment Details | |
| Receipt Amount | $1,996.00 |
| Receipt Date | 07/05/2022 |
| Comments | hotel stay at Studio 6 arrival day 7/6/22 for 30 days |
| Receipt | 05-07-2022Mcbride0.00.pdf |
| Staff Name | Gloria Jimenez |
| Case Manager | DG |
| Verifier Name | Gloria Jimenez |
| Verifier Signature | |
| Date Verified | 07/05/2022 |
