| Payment ID | 2059 |
|---|---|
| Date Created | 06/13/22 3:23 pm |
| Created By | Gloria Jimenez |
| Service Request | |
| Application ID | 375 |
| Authorization Number | |
| Applicant Information | |
| Name | Whitney Comer |
| Unique Identifier | 16170700041 |
| Payment Type | Short-Term Hotel/Motel Stays |
| Payment Details | |
| Receipt Amount | $854.00 |
| Receipt Date | 06/13/2022 |
| Comments | extended stay |
| Staff Name | Yolanda Salazar |
| Staff Signature | |
| Verifier Name | Gloria JImenez |
| Verifier Signature | |
| Date Verified | 06/13/2022 |
