| Payment ID | 4921 |
|---|---|
| Date Created | 07/31/22 1:15 pm |
| Created By | Gloria Jimenez |
| Service Request | |
| Application ID | 3647 |
| Authorization Number | |
| Applicant Information | |
| Name | Tyeisha Meyer |
| Applicant Email Address | Email hidden; Javascript is required. |
| Unique Identifier | 16170600345 |
| Payment Type | Short-Term Hotel/Motel Stays |
| Payment Details | |
| Receipt Amount | $1,953.51 |
| Receipt Date | 07/29/2022 |
| Comments | hotel stay at Woodspring from 7/29 through 8/26/2022 |
| Receipt | 29-07-2022Meyer0.00.pdf |
| Staff Name | Gloria Jimenez |
| Case Manager | AL |
| Verifier Name | Gloria Jimenez |
| Verifier Signature | |
| Date Verified | 07/31/2022 |
