| Payment ID | 5215 |
|---|---|
| Date Created | 08/04/22 1:53 pm |
| Created By | Gloria Jimenez |
| Service Request | |
| Application ID | 1208 |
| Authorization Number | |
| Applicant Information | |
| Name | Ronnie White |
| Applicant Email Address | Email hidden; Javascript is required. |
| Unique Identifier | 16171200145 |
| Payment Type | Short-Term Hotel/Motel Stays |
| Payment Details | |
| Receipt Amount | $779.32 |
| Receipt Date | 08/03/2022 |
| Comments | extended at Woodspring departure date is 8/5/2022 |
| Receipt | 03-08-2022White0.00.pdf |
| Staff Name | Gloria Jimenez |
| Case Manager | AL |
| Verifier Name | Gloria Jimenez |
| Verifier Signature | |
| Date Verified | 08/04/2022 |
