| Payment ID | 8139 |
|---|---|
| Date Created | 09/14/22 4:19 pm |
| Created By | Gloria Jimenez |
| Service Request | |
| Application ID | 3566 |
| Authorization Number | |
| Applicant Information | |
| Name | Patricia Jones |
| Applicant Email Address | Email hidden; Javascript is required. |
| Unique Identifier | 16170600340 |
| Payment Type | Short-Term Hotel/Motel Stays |
| Payment Details | |
| Receipt Amount | $79.27 |
| Receipt Date | 09/14/2022 |
| Comments | hotel stay payment for one night |
| Receipt | 8139-Jones.pdf |
| Staff Name | Gloria Jimenez |
| Case Manager | BJ |
| Verifier Name | Gloria Jimenez |
| Verifier Signature | |
| Date Verified | 09/14/2022 |
