| Payment ID | 8284 |
|---|---|
| Date Created | 09/19/22 1:02 pm |
| Created By | Gloria Jimenez |
| Service Request | |
| Application ID | 3698 |
| Authorization Number | |
| Applicant Information | |
| Name | julia mahan |
| Applicant Email Address | Email hidden; Javascript is required. |
| Unique Identifier | 16171000342 |
| Payment Type | Short-Term Hotel/Motel Stays |
| Payment Details | |
| Receipt Amount | $65.55 |
| Receipt Date | 09/14/2022 |
| Comments | extended stay at Woodspring Suites paid 9/14/22 |
| Receipt | 8284-mahan.pdf |
| Staff Name | Gloria Jimenez |
| Case Manager | BJ |
| Verifier Name | Gloria Jimenez |
| Verifier Signature | |
| Date Verified | 09/19/2022 |
