| Payment ID | 7281 |
|---|---|
| Date Created | 08/31/22 10:58 am |
| Created By | Gloria Jimenez |
| Service Request | |
| Application ID | 5345 |
| Authorization Number | |
| Applicant Information | |
| Name | Jonathan Richards |
| Applicant Email Address | Email hidden; Javascript is required. |
| Unique Identifier | 16170400492 |
| Payment Type | Short-Term Hotel/Motel Stays |
| Payment Details | |
| Receipt Amount | $893.65 |
| Receipt Date | 08/30/2022 |
| Comments | hotel stay paid 2 weeks out of 30 days at Woodspring departure date 9/15/2022 |
| Receipt | |
| Staff Name | Gloria Jimenez |
| Case Manager | BP |
| Verifier Name | Gloria Jimenez |
| Verifier Signature | |
| Date Verified | 08/31/2022 |
