| Payment ID | 3663 |
|---|---|
| Date Created | 07/07/22 10:25 am |
| Created By | Gloria Jimenez |
| Service Request | |
| Application ID | 1807 |
| Authorization Number | |
| Applicant Information | |
| Name | Darnell Jackson |
| Applicant Email Address | Email hidden; Javascript is required. |
| Unique Identifier | 16154900200 |
| Payment Type | Short-Term Hotel/Motel Stays |
| Payment Details | |
| Receipt Amount | $100.00 |
| Receipt Date | 06/27/2022 |
| Comments | short hotel stay at the Heritage Quarters |
| Staff Name | Gloria Jimenez |
| Case Manager | BP |
| Verifier Name | Gloria Jimenez |
| Verifier Signature | |
| Date Verified | 06/27/2022 |
