| Payment ID | 4893 |
|---|---|
| Date Created | 07/31/22 12:19 pm |
| 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 | $349.02 |
| Receipt Date | 07/26/2022 |
| Comments | extended stay at woodspring departure date 8/1/2022 |
| Receipt | 26-07-2022Hollie349.02.pdf |
| Staff Name | Gloria Jimenez |
| Case Manager | AL |
| Verifier Name | Gloria Jimenez |
| Verifier Signature | |
| Date Verified | 07/31/2022 |
