| Payment ID | 4900 |
|---|---|
| Date Created | 07/31/22 12:36 pm |
| Created By | Gloria Jimenez |
| Service Request | |
| Application ID | 3972 |
| Authorization Number | |
| Applicant Information | |
| Name | Elizabeth Mahon |
| Applicant Email Address | Email hidden; Javascript is required. |
| Unique Identifier | 16171400374 |
| Payment Type | Short-Term Hotel/Motel Stays |
| Payment Details | |
| Receipt Amount | $2,363.01 |
| Receipt Date | 07/27/2022 |
| Comments | hotel stay at Motel 6 arrival 7/27 through 8/26 |
| Receipt | 27-07-2022Mahon0.00.pdf |
| Staff Name | Gloria Jimenez |
| Case Manager | DG |
| Verifier Name | Gloria Jimenez |
| Verifier Signature | |
| Date Verified | 07/31/2022 |
