| Payment ID | 8735 |
|---|---|
| Date Created | 09/26/22 1:06 pm |
| Created By | Gloria Jimenez |
| Service Request | |
| Application ID | 5487 |
| Authorization Number | |
| Applicant Information | |
| Name | Ashley Conner |
| Applicant Email Address | Email hidden; Javascript is required. |
| Unique Identifier | 16170400506 |
| Payment Type | Short-Term Hotel/Motel Stays |
| Payment Details | |
| Receipt Amount | $1,323.84 |
| Receipt Date | 09/22/2022 |
| Comments | hotel stay at Super 8 arrival date 9/22/2022 departure date 10/06/2022 |
| Staff Name | Gloria Jimenez |
| Case Manager | DG |
| Verifier Name | Gloria Jimenez |
| Verifier Signature | |
| Date Verified | 09/26/2022 |
