| Payment ID | 7741 |
|---|---|
| Date Created | 09/07/22 2:56 pm |
| Created By | Gloria Jimenez |
| Service Request | |
| Application ID | 3851 |
| Authorization Number | |
| Applicant Information | |
| Name | Brittany Dickson |
| Applicant Email Address | Email hidden; Javascript is required. |
| Unique Identifier | 16171100366 |
| Payment Type | Short-Term Hotel/Motel Stays |
| Payment Details | |
| Receipt Amount | $498.38 |
| Receipt Date | 08/09/2022 |
| Comments | hotel stay at Woodspring |
| Receipt | 7741-Dickson.pdf |
| Staff Name | Gloria Jimenez |
| Case Manager | BP |
| Verifier Name | Gloria Jimenez |
| Verifier Signature | |
| Date Verified | 09/07/2022 |
