| Payment ID | 3978 |
|---|---|
| Date Created | 07/13/22 12:01 pm |
| Created By | Gloria Jimenez |
| Service Request | |
| Application ID | 1768 |
| Authorization Number | |
| Applicant Information | |
| Name | Wyneishea Dawson |
| Applicant Email Address | Email hidden; Javascript is required. |
| Unique Identifier | 16170400192 |
| Payment Type | Short-Term Hotel/Motel Stays |
| Payment Details | |
| Receipt Amount | $2,760.00 |
| Receipt Date | 07/06/2022 |
| Comments | hotel stay at Fairfield Inn. 30 days departure date is 8/5/2022 |
| Receipt | 06-07-2022Dawson2760.00.pdf |
| Staff Name | Gloria Jimenez |
| Case Manager | CC |
| Verifier Name | Gloria Jimenez |
| Verifier Signature | |
| Date Verified | 07/13/2022 |
