| Payment ID | 3946 |
|---|---|
| Date Created | 07/12/22 2:59 pm |
| Created By | Gloria Jimenez |
| Service Request | |
| Application ID | 1208 |
| Authorization Number | |
| Applicant Information | |
| Name | Ronnie White |
| Applicant Email Address | Email hidden; Javascript is required. |
| Unique Identifier | 16171200145 |
| Payment Type | Short-Term Hotel/Motel Stays |
| Payment Details | |
| Receipt Amount | $757.96 |
| Receipt Date | 07/07/2022 |
| Comments | extended stay at Woodspring Suites departure date is 7/23/2022 |
| Receipt | 07-07-2022White0.00.pdf |
| Staff Name | Gloria Jimenez |
| Case Manager | AL |
| Verifier Name | Gloria Jimenez |
| Verifier Signature | |
| Date Verified | 07/12/2022 |
