| Payment ID | 4531 |
|---|---|
| Date Created | 07/26/22 12:51 pm |
| Created By | Gloria Jimenez |
| Service Request | |
| Application ID | 3712 |
| Authorization Number | |
| Applicant Information | |
| Name | Jordan Hamilton |
| Applicant Email Address | Email hidden; Javascript is required. |
| Unique Identifier | 16170600352 |
| Payment Type | Short-Term Hotel/Motel Stays |
| Payment Details | |
| Receipt Amount | $1,220.10 |
| Receipt Date | 07/14/2022 |
| Comments | Hotel stay at Super 8 arrival date 7/15 thru 7/28 |
| Receipt | 14-07-2022Hamilton1220.10.pdf |
| Staff Name | Gloria Jimenez |
| Case Manager | AL |
| Verifier Name | Gloria Jimenez |
| Verifier Signature | |
| Date Verified | 07/26/2022 |
