| Payment ID | 4914 |
|---|---|
| Date Created | 07/31/22 1:04 pm |
| Created By | Gloria Jimenez |
| Service Request | |
| Application ID | 3684 |
| Authorization Number | |
| Applicant Information | |
| Name | Loria Crane |
| Applicant Email Address | Email hidden; Javascript is required. |
| Unique Identifier | 16170400349 |
| Payment Type | Short-Term Hotel/Motel Stays |
| Payment Details | |
| Receipt Amount | $1,861.00 |
| Receipt Date | 07/28/2022 |
| Comments | hotel stay at Woospring from 7/28/2022 through 8/25/2022 |
| Receipt | 28-07-2022Crane0.00.pdf |
| Staff Name | Gloria Jimenez |
| Case Manager | BP |
| Verifier Name | Gloria Jimenez |
| Verifier Signature | |
| Date Verified | 07/31/2022 |
