| Payment ID | 9783 |
|---|---|
| Date Created | 10/17/22 3:23 pm |
| Created By | Gloria Jimenez |
| Service Request | |
| Application ID | 7675 |
| Authorization Number | |
| Applicant Information | |
| Name | Kayla Garza |
| Applicant Email Address | Email hidden; Javascript is required. |
| Unique Identifier | 11070500625 |
| Payment Type | Short-Term Hotel/Motel Stays |
| Payment Details | |
| Receipt Amount | $420.00 |
| Receipt Date | 10/13/2022 |
| Comments | hotel stay at Econolodge departure date is 10/24/2022 |
| Receipt | |
| Staff Name | Gloria Jimenez |
| Case Manager | DG |
| Verifier Name | Gloria Jimenez |
| Verifier Signature | |
| Date Verified | 10/17/2022 |
