| Payment ID | 4898 |
|---|---|
| Date Created | 07/31/22 12:32 pm |
| Created By | Gloria Jimenez |
| Service Request | |
| Application ID | 3497 |
| Authorization Number | |
| Applicant Information | |
| Name | Gregory Cox |
| Agency Name | Caritas |
| Agency Code | 220209 |
| Agency | Caritas |
| Agency Email Address | Email hidden; Javascript is required. |
| Applicant Email Address | Email hidden; Javascript is required. |
| Unique Identifier | 16171000334 |
| Payment Type | Short-Term Hotel/Motel Stays |
| Payment Details | |
| Receipt Amount | $1,300.00 |
| Receipt Date | 07/27/2022 |
| Comments | hotel stay at Sandman arrival 7/27/22 through 8/24/2022 |
| Receipt | 27-07-2022Cox1300.00.pdf |
| Staff Name | Gloria Jimenez |
| Case Manager | DG |
| Verifier Name | Gloria Jimenez |
| Verifier Signature | |
| Date Verified | 07/31/2022 |
