| Payment ID | 3515 |
|---|---|
| Date Created | 07/05/22 4:06 pm |
| Created By | Gloria Jimenez |
| Service Request | |
| Application ID | 2570 |
| Authorization Number | |
| Applicant Information | |
| Name | Angela Castro Rivera |
| Applicant Email Address | Email hidden; Javascript is required. |
| Unique Identifier | 16170500238 |
| Payment Type | Short-Term Hotel/Motel Stays |
| Payment Details | |
| Receipt Amount | $1,740.00 |
| Receipt Date | 06/30/2022 |
| Comments | Studio 6 hotel stay for 30 days. |
| Staff Name | Gloria Jimenez |
| Case Manager | AL |
| Verifier Name | Gloria Jimenez |
| Verifier Signature | |
| Date Verified | 07/05/2022 |
