| Payment ID | 8316 |
|---|---|
| Date Created | 09/19/22 2:44 pm |
| Created By | Gloria Jimenez |
| Service Request | |
| Application ID | 6139 |
| Authorization Number | |
| Applicant Information | |
| Name | Nyanpal Top |
| Applicant Email Address | Email hidden; Javascript is required. |
| Unique Identifier | 16170100545 |
| Payment Type | Short-Term Hotel/Motel Stays |
| Payment Details | |
| Receipt Amount | -$79.00 |
| Receipt Date | 09/19/2022 |
| Comments | refund for a night stay at Super 8. |
| Receipt | 8316-Top.pdf |
| Staff Name | Gloria Jimenez |
| Case Manager | DG |
| Verifier Name | Gloria Jimenez |
| Verifier Signature | |
| Date Verified | 09/19/2022 |
