| Payment ID | 12673 |
|---|---|
| Date Created | 11/29/22 7:45 pm |
| Created By | Gloria Jimenez |
| Service Request | |
| Application ID | 7986 |
| Authorization Number | |
| Applicant Information | |
| Name | Kainbrell Brown |
| Applicant Email Address | Email hidden; Javascript is required. |
| Unique Identifier | 16171000650 |
| Payment Type | Short-Term Hotel/Motel Stays |
| Payment Details | |
| Receipt Amount | $1,869.00 |
| Receipt Date | 11/29/2022 |
| Comments | hotel stay at Super 8. departure date is 12/20/22 |
| Receipt | 29-11-2022Brown1869.00.pdf |
| Staff Name | Gloria Jimenez |
| Case Manager | DJ |
| Verifier Name | Gloria Jimenez |
| Verifier Signature | |
| Date Verified | 11/29/2022 |
