| Payment ID | 5416 |
|---|---|
| Date Created | 08/09/22 2:04 pm |
| Created By | Gloria Jimenez |
| Service Request | |
| Application ID | 2791 |
| Authorization Number | |
| Applicant Information | |
| Name | Joseph McDonald |
| Applicant Email Address | Email hidden; Javascript is required. |
| Unique Identifier | 16170800269 |
| Payment Type | Short-Term Hotel/Motel Stays |
| Payment Details | |
| Receipt Amount | $2,370.00 |
| Receipt Date | 07/27/2022 |
| Comments | hotel stay at Super 8 from 7/28 through 8/26 |
| Staff Name | Gloria Jimenez |
| Case Manager | CC |
| Verifier Name | Gloria Jimenez |
| Verifier Signature | |
| Date Verified | 08/09/2022 |
