| Payment ID | 7746 |
|---|---|
| Date Created | 09/07/22 3:44 pm |
| Created By | Gloria Jimenez |
| Service Request | |
| Application ID | 6401 |
| Authorization Number | |
| Applicant Information | |
| Name | Cosheanna Robinson |
| Applicant Email Address | Email hidden; Javascript is required. |
| Unique Identifier | 16170400566 |
| Payment Type | Short-Term Hotel/Motel Stays |
| Payment Details | |
| Receipt Amount | $706.87 |
| Receipt Date | 09/01/2022 |
| Comments | hotel stay at Woodspring Suites |
| Receipt | |
| Staff Name | Gloria Jimenez |
| Case Manager | DG |
| Verifier Name | Gloria Jimenez |
| Verifier Signature | |
| Date Verified | 09/07/2022 |
