| Payment ID | 4019 |
|---|---|
| Date Created | 07/14/22 11:06 am |
| Created By | Gloria Jimenez |
| Service Request | |
| Application ID | 462 |
| Authorization Number | |
| Applicant Information | |
| Name | Jasmaine Hollie |
| Applicant Email Address | Email hidden; Javascript is required. |
| Unique Identifier | 16170700064 |
| Payment Type | Short-Term Hotel/Motel Stays |
| Payment Details | |
| Receipt Amount | $824.75 |
| Receipt Date | 07/12/2022 |
| Comments | extended stay at Woodspring Suites departure date is 7/25/22 |
| Receipt | 12-07-2022Hollie824.75.pdf |
| Staff Name | Gloria Jimenez |
| Case Manager | AL |
| Verifier Name | Gloria Jimenez |
| Verifier Signature | |
| Date Verified | 07/14/2022 |
