| Payment ID | 8286 |
|---|---|
| Date Created | 09/19/22 1:15 pm |
| Created By | Gloria Jimenez |
| Service Request | |
| Application ID | 462 |
| Authorization Number | |
| Applicant Information | |
| Name | Jasmaine Hollie |
| Applicant Email Address | Email hidden; Javascript is required. |
| Unique Identifier | 16170700064 |
| Payment Type | Short-Term Hotel/Motel Stays |
| Payment Details | |
| Receipt Amount | $62.26 |
| Receipt Date | 09/14/2022 |
| Comments | extended stay at Woodspring paid for one day |
| Receipt | 8286-Hollie.pdf |
| Staff Name | Gloria Jimenez |
| Case Manager | AL |
| Verifier Name | Gloria Jimenez |
| Verifier Signature | |
| Date Verified | 09/19/2022 |
