| Payment ID | 2985 |
|---|---|
| Date Created | 06/24/22 9:45 am |
| Created By | Gloria Jimenez |
| Service Request | |
| Application ID | 2274 |
| Authorization Number | |
| Applicant Information | |
| Name | Mashun Thornton |
| Unique Identifier | 16170400221 |
| Payment Type | Short-Term Hotel/Motel Stays |
| Payment Details | |
| Receipt Amount | $2,370.00 |
| Receipt Date | 06/21/2022 |
| Comments | super 8 stay 6/21/22 through 7/21/22 |
| Staff Name | Gloria Jimenez |
| Case Manager | AL |
| Verifier Name | Gloria Jimenez |
| Verifier Signature | |
| Date Verified | 06/21/2022 |
