| Payment ID | 7090 |
|---|---|
| Date Created | 08/29/22 3:21 pm |
| Created By | Gloria Jimenez |
| Service Request | |
| Application ID | 1951 |
| Authorization Number | |
| Applicant Information | |
| Name | West Wilson |
| Agency Email Address | Email hidden; Javascript is required. |
| Applicant Email Address | Email hidden; Javascript is required. |
| Unique Identifier | 16170600212 |
| Payment Type | Short-Term Hotel/Motel Stays |
| Payment Details | |
| Receipt Amount | $1,106.00 |
| Receipt Date | 08/01/2022 |
| Comments | extended stay at Super 8 paid on 8/1/22 departure date 8/19/22 |
| Receipt | |
| Staff Name | Gloria Jimenez |
| Case Manager | AL |
| Verifier Name | Gloria Jimenez |
| Verifier Signature | |
| Date Verified | 08/29/2022 |
