| Payment ID | 5344 |
|---|---|
| Date Created | 08/08/22 2:27 pm |
| Created By | Gloria Jimenez |
| Service Request | |
| Application ID | 209 |
| Authorization Number | |
| Applicant Information | |
| Name | Lawrence Bisby |
| Applicant Email Address | Email hidden; Javascript is required. |
| Unique Identifier | 11064500022 |
| Payment Type | Short-Term Hotel/Motel Stays |
| Payment Details | |
| Receipt Amount | $1,740.20 |
| Receipt Date | 07/05/2022 |
| Comments | extended hotel stay |
| Receipt | 05-07-2022Bisby1740.20.pdf |
| Staff Name | Gloria Jimenez |
| Case Manager | BP |
| Verifier Name | Gloria Jimenez |
| Verifier Signature | |
| Date Verified | 08/08/2022 |
