| Payment ID | 9526 |
|---|---|
| Date Created | 10/12/22 12:43 pm |
| Created By | Gloria Jimenez |
| Service Request | |
| Application ID | 6653 |
| Authorization Number | |
| Applicant Information | |
| Name | Alfred Battle |
| Agency Name | Veterans Administration |
| Agency Code | 220308 |
| Agency | Veterans Administration |
| Agency Email Address | Email hidden; Javascript is required. |
| Applicant Email Address | Email hidden; Javascript is required. |
| Unique Identifier | 16170600586 |
| Payment Type | Short-Term Hotel/Motel Stays |
| Payment Details | |
| Receipt Amount | $267.00 |
| Receipt Date | 10/03/2022 |
| Comments | hotel stay paid on 10/03/2022 |
| Receipt | |
| Staff Name | Gloria Jimenez |
| Case Manager | AL |
| Verifier Name | Gloria Jimenez |
| Verifier Signature | |
| Date Verified | 10/12/2022 |
