| Payment ID | 7959 |
|---|---|
| Date Created | 09/12/22 3:36 pm |
| Created By | Gloria Jimenez |
| Service Request | |
| Application ID | 197 |
| Authorization Number | |
| Applicant Information | |
| Name | Danielle Vallian |
| Agency Name | Unknown |
| Applicant Email Address | Email hidden; Javascript is required. |
| Unique Identifier | 16170700013 |
| Payment Type | Short-Term Hotel/Motel Stays |
| Payment Details | |
| Receipt Amount | $378.98 |
| Receipt Date | 06/30/2022 |
| Comments | entering hotel stay that was not updated on June 30, 2022 |
| Staff Name | Gloria Jimenez |
| Case Manager | BJ |
| Verifier Name | Gloria Jimenez |
| Verifier Signature | |
| Date Verified | 09/12/2022 |
