| Payment ID | 9216 |
|---|---|
| Date Created | 10/05/22 10:45 am |
| Created By | Gloria Jimenez |
| Service Request | |
| Application ID | 1951 |
| Authorization Number | |
| Applicant Information | |
| Name | West Wilson |
| Agency Email Address | Email hidden; Javascript is required. |
| Applicant Email Address | Email hidden; Javascript is required. |
| Unique Identifier | 16170600212 |
| Payment Type | Short-Term Hotel/Motel Stays |
| Payment Details | |
| Receipt Amount | $553.00 |
| Receipt Date | 10/04/2022 |
| Comments | hotel extension at Super 8 departure date is 10/17/22 |
| Receipt | 9216-Wilson.pdf |
| Staff Name | Gloria Jimenez |
| Case Manager | AL |
| Verifier Name | Gloria Jimenez |
| Verifier Signature | |
| Date Verified | 10/05/2022 |
