| Payment ID | 5342 |
|---|---|
| Date Created | 08/08/22 2:15 pm |
| Created By | Gloria Jimenez |
| Service Request | |
| Application ID | 1498 |
| Authorization Number | |
| Applicant Information | |
| Name | Elizabeth Taylor |
| Applicant Email Address | Email hidden; Javascript is required. |
| Unique Identifier | 16170800154 |
| Payment Type | Short-Term Hotel/Motel Stays |
| Payment Details | |
| Receipt Amount | $1,126.86 |
| Receipt Date | 07/06/2022 |
| Comments | hotel stay |
| Receipt | 06-07-2022Taylor1126.86.pdf |
| Staff Name | Gloria Jimenez |
| Case Manager | CC |
| Verifier Name | Gloria Jimenez |
| Verifier Signature | |
| Date Verified | 08/08/2022 |
