| Payment ID | 6304 |
|---|---|
| Date Created | 08/22/22 2:37 pm |
| Created By | Gloria Jimenez |
| Service Request | |
| Application ID | 4649 |
| Authorization Number | |
| Applicant Information | |
| Name | James Muncy |
| Applicant Email Address | Email hidden; Javascript is required. |
| Unique Identifier | 16170600432 |
| Payment Type | Short-Term Hotel/Motel Stays |
| Payment Details | |
| Receipt Amount | $1,573.00 |
| Receipt Date | 08/16/2022 |
| Comments | extended hotel stay at motel 6 departure date is 9/9/2022 |
| Receipt | 6304-Muncy.pdf |
| Staff Name | Gloria Jimenez |
| Case Manager | BP |
| Verifier Name | Gloria Jimenez |
| Verifier Signature | |
| Date Verified | 08/22/2022 |
