| Payment ID | 3613 |
|---|---|
| Date Created | 07/06/22 4:11 pm |
| Created By | Gloria Jimenez |
| Service Request | |
| Application ID | 2343 |
| Authorization Number | |
| Applicant Information | |
| Name | Louis Welch Jr. |
| Agency Email Address | Email hidden; Javascript is required. |
| Applicant Email Address | Email hidden; Javascript is required. |
| Unique Identifier | 16169200225 |
| Payment Type | Short-Term Hotel/Motel Stays |
| Payment Details | |
| Receipt Amount | $1,740.00 |
| Receipt Date | 06/16/2022 |
| Comments | hotel stay at Lonestar Motel for 30 days starting in June |
| Staff Name | Gloria Jimenez |
| Case Manager | DG |
| Verifier Name | Gloria Jimenez |
| Verifier Signature | |
| Date Verified | 06/16/2022 |
