| Payment ID | 4953 |
|---|---|
| Date Created | 08/01/22 10:50 am |
| Created By | Gloria Jimenez |
| Service Request | |
| Application ID | 4373 |
| Authorization Number | |
| Applicant Information | |
| Name | Bruce Galbert |
| 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 | 16170400411 |
| Payment Type | Short-Term Hotel/Motel Stays |
| Payment Details | |
| Receipt Amount | $2,370.00 |
| Receipt Date | 07/28/2022 |
| Comments | hotel stay at Super 8 for 30 days departure date is 8/27/2022 |
| Receipt | 28-07-2022Galbert0.00.pdf |
| Staff Name | Gloria Jimenez |
| Case Manager | AL |
| Verifier Name | Gloria Jimenez |
| Verifier Signature | |
| Date Verified | 08/01/2022 |
