| Payment ID | 9222 |
|---|---|
| Date Created | 10/05/22 11:08 am |
| Created By | Gloria Jimenez |
| Service Request | |
| Application ID | 5257 |
| Authorization Number | |
| Applicant Information | |
| Name | Tannar Davidson |
| Applicant Email Address | Email hidden; Javascript is required. |
| Unique Identifier | 16170600483 |
| Payment Type | Short-Term Hotel/Motel Stays |
| Payment Details | |
| Receipt Amount | $612.90 |
| Receipt Date | 10/04/2022 |
| Comments | hotel extension at Studio 6 departure date is 10/13/22 |
| Receipt | 9222-Davidson.pdf |
| Staff Name | Gloria Jimenez |
| Case Manager | BJ |
| Verifier Name | Gloria Jimenez |
| Verifier Signature | |
| Date Verified | 10/05/2022 |
