| Payment ID | 3659 |
|---|---|
| Date Created | 07/07/22 9:53 am |
| Created By | Gloria Jimenez |
| Service Request | |
| Application ID | 1947 |
| Authorization Number | |
| Applicant Information | |
| Name | Tanzeneka Jackson |
| Applicant Email Address | Email hidden; Javascript is required. |
| Unique Identifier | 14764200210 |
| Payment Type | Short-Term Hotel/Motel Stays |
| Payment Details | |
| Receipt Amount | $1,650.00 |
| Receipt Date | 06/23/2022 |
| Comments | hotel stay at the Lonestar Inn in Groesbeck starting 6/23/22 |
| Staff Name | Gloria Jimenez |
| Case Manager | AL |
| Verifier Name | Gloria Jimenez |
| Verifier Signature | |
| Date Verified | 06/23/2022 |
