| Payment ID | 6887 |
|---|---|
| Date Created | 08/29/22 12:47 pm |
| Created By | Gloria Jimenez |
| Service Request | |
| Application ID | 2784 |
| Authorization Number | |
| Applicant Information | |
| Name | Earl Taylor |
| Applicant Email Address | Email hidden; Javascript is required. |
| Unique Identifier | 16100000268 |
| Payment Type | Short-Term Hotel/Motel Stays |
| Payment Details | |
| Receipt Amount | $1,800.90 |
| Receipt Date | 08/23/2022 |
| Comments | hotel stay at Lone Star arrival date 8/23/2022 departure date is 9/22/2022 |
| Receipt | 6887-Taylor.pdf |
| Staff Name | Gloria Jimenez |
| Case Manager | AL |
| Verifier Name | Gloria Jimenez |
| Verifier Signature | |
| Date Verified | 08/29/2022 |
