| Payment ID | 7365 |
|---|---|
| Date Created | 08/31/22 2:57 pm |
| Created By | Gloria Jimenez |
| Service Request | |
| Application ID | 6474 |
| Authorization Number | |
| Applicant Information | |
| Name | Bernice segoviano |
| Applicant Email Address | Email hidden; Javascript is required. |
| Unique Identifier | 07466100573 |
| Payment Type | Short-Term Hotel/Motel Stays |
| Payment Details | |
| Receipt Amount | $1,086.03 |
| Receipt Date | 08/31/2022 |
| Comments | hotel stay at Super 8 arrival date 9/1/2022 departure date is 9/12/2022 |
| Receipt | 7365-segoviano.pdf |
| Staff Name | Gloria Jimenez |
| Case Manager | LRE |
| Verifier Name | Gloria Jimenez |
| Verifier Signature | |
| Date Verified | 08/31/2022 |
