| Payment ID | 8804 |
|---|---|
| Date Created | 09/27/22 10:12 am |
| Created By | Gloria Jimenez |
| Service Request | |
| Application ID | 471 |
| Authorization Number | |
| Applicant Information | |
| Name | Charles Reed |
| Agency Name | Unknown |
| Applicant Email Address | Email hidden; Javascript is required. |
| Unique Identifier | 16170700065 |
| Payment Type | Short-Term Hotel/Motel Stays |
| Payment Details | |
| Receipt Amount | -$919.30 |
| Receipt Date | 09/22/2022 |
| Comments | refund from extended stay, due to changing to super 8 |
| Staff Name | Gloria Jimenez |
| Case Manager | BP |
| Verifier Name | Gloria Jimenez |
| Verifier Signature | |
| Date Verified | 09/27/2022 |
