| Payment ID | 8404 |
|---|---|
| Date Created | 09/20/22 11:01 am |
| Created By | Gloria Jimenez |
| Service Request | |
| Application ID | 195 |
| Authorization Number | |
| Applicant Information | |
| Name | Ashlee Cockrell |
| Applicant Email Address | Email hidden; Javascript is required. |
| Unique Identifier | 16171100011 |
| Payment Type | Short-Term Hotel/Motel Stays |
| Payment Details | |
| Receipt Amount | $1,093.68 |
| Receipt Date | 09/15/2022 |
| Comments | extended stay at woodspring paid on 9/15/2022 departure date is 10/03/2022 |
| Receipt | 8404-Cockrell.pdf |
| Staff Name | Gloria Jimenez |
| Case Manager | BJ |
| Verifier Name | Gloria Jimenez |
| Verifier Signature | |
| Date Verified | 09/20/2022 |
