| Payment ID | 7284 |
|---|---|
| Date Created | 08/31/22 11:05 am |
| Created By | Gloria Jimenez |
| Service Request | |
| Application ID | 3192 |
| Authorization Number | |
| Applicant Information | |
| Name | Daniel Webber |
| Agency Name | Caritas |
| Agency Code | 220209 |
| Agency | Caritas |
| Agency Email Address | Email hidden; Javascript is required. |
| Applicant Email Address | Email hidden; Javascript is required. |
| Unique Identifier | 16170800303 |
| Payment Type | Short-Term Hotel/Motel Stays |
| Payment Details | |
| Receipt Amount | $178.00 |
| Receipt Date | 08/30/2022 |
| Comments | extended stay at Super 8 departure date is 8/30/2022 |
| Receipt | |
| Staff Name | Gloria Jimenez |
| Case Manager | AL |
| Verifier Name | Gloria Jimenez |
| Verifier Signature | |
| Date Verified | 08/31/2022 |
