| Payment ID | 8984 |
|---|---|
| Date Created | 09/29/22 9:12 am |
| 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 | $87.40 |
| Receipt Date | 09/27/2022 |
| Comments | paid for one night 9/22/22 |
| Receipt | 8984-Conner.pdf |
| Staff Name | Gloria Jimenez |
| Case Manager | DG |
| Verifier Name | Gloria Jimenez |
| Verifier Signature | |
| Date Verified | 09/29/2022 |
