| Payment ID | 8032 |
|---|---|
| Date Created | 09/13/22 11:34 am |
| Created By | Gloria Jimenez |
| Service Request | |
| Application ID | 2537 |
| Authorization Number | |
| Applicant Information | |
| Name | Kenneth Mardis |
| Applicant Email Address | Email hidden; Javascript is required. |
| Unique Identifier | 16170400233 |
| Payment Type | Short-Term Hotel/Motel Stays |
| Payment Details | |
| Receipt Amount | $632.50 |
| Receipt Date | 09/01/2022 |
| Comments | hotel stay at America Best Value Inn arrival date is 9/1/2022 through 9/8/2022 |
| Receipt | 8032-Mardis.pdf |
| Staff Name | Gloria Jimenez |
| Case Manager | BP |
| Verifier Name | Gloria Jimenez |
| Verifier Signature | |
| Date Verified | 09/13/2022 |
