| Payment ID | 4902 |
|---|---|
| Date Created | 07/31/22 12:39 pm |
| Created By | Gloria Jimenez |
| Service Request | |
| Application ID | 2570 |
| Authorization Number | |
| Applicant Information | |
| Name | Angela Castro Rivera |
| Applicant Email Address | Email hidden; Javascript is required. |
| Unique Identifier | 16170500238 |
| Payment Type | Short-Term Hotel/Motel Stays |
| Payment Details | |
| Receipt Amount | $852.44 |
| Receipt Date | 07/27/2022 |
| Comments | hotel extended stay from 7/27 through 8/10 |
| Receipt | 27-07-2022Castro-Rivera0.00.pdf |
| Staff Name | Gloria Jimenez |
| Case Manager | AL |
| Verifier Name | Gloria Jimenez |
| Verifier Signature | |
| Date Verified | 07/31/2022 |
