| Payment ID | 5105 |
|---|---|
| Date Created | 08/03/22 10:34 am |
| Created By | Gloria Jimenez |
| Service Request | |
| Application ID | 197 |
| Authorization Number | |
| Applicant Information | |
| Name | Danielle Vallian |
| Agency Name | Unknown |
| Applicant Email Address | Email hidden; Javascript is required. |
| Unique Identifier | 16170700013 |
| Payment Type | Short-Term Hotel/Motel Stays |
| Payment Details | |
| Receipt Amount | $424.66 |
| Receipt Date | 08/01/2022 |
| Comments | extended stay at Woodspring departure date is 8/8/22 |
| Receipt | 5105-Vallian.pdf |
| Staff Name | Gloria Jimenez |
| Case Manager | BJ |
| Verifier Name | Gloria Jimenez |
| Verifier Signature | |
| Date Verified | 08/03/2022 |
