| Payment ID | 5106 |
|---|---|
| Date Created | 08/03/22 10:37 am |
| Created By | Gloria Jimenez |
| Service Request | |
| Application ID | 2816 |
| Authorization Number | |
| Applicant Information | |
| Name | Beyonka Caldwell |
| Agency Name | Family Abuse Center |
| Agency Code | 220210 |
| Agency | Family Abuse Center |
| Agency Email Address | Email hidden; Javascript is required. |
| Applicant Email Address | Email hidden; Javascript is required. |
| Unique Identifier | 16170200272 |
| Payment Type | Short-Term Hotel/Motel Stays |
| Payment Details | |
| Receipt Amount | $1,985.54 |
| Receipt Date | 08/01/2022 |
| Comments | hotel stay at Woodspring for 30 days |
| Receipt | 5106-Caldwell.pdf |
| Staff Name | Gloria Jimenez |
| Case Manager | DG |
| Verifier Name | Gloria Jimenez |
| Verifier Signature | |
| Date Verified | 08/03/2022 |
