| Payment ID | 6346 |
|---|---|
| Date Created | 08/22/22 5:05 pm |
| Created By | Gloria Jimenez |
| Service Request | |
| Application ID | 5040 |
| Authorization Number | |
| Applicant Information | |
| Name | Mary Williams |
| Applicant Email Address | Email hidden; Javascript is required. |
| Unique Identifier | 16170800460 |
| Payment Type | Short-Term Hotel/Motel Stays |
| Payment Details | |
| Receipt Amount | $2,188.65 |
| Receipt Date | 08/19/2022 |
| Comments | hotel stay at Studio 6 arrival 8/19/2022 departure date 9/19/2022 |
| Receipt | 6346-Williams.pdf |
| Staff Name | Gloria Jimenez |
| Case Manager | DG |
| Verifier Name | Gloria Jimenez |
| Verifier Signature | |
| Date Verified | 08/22/2022 |
