| Payment ID | 3691 |
|---|---|
| Date Created | 07/07/22 1:14 pm |
| Created By | Gloria Jimenez |
| Service Request | |
| Application ID | 949 |
| Authorization Number | |
| Applicant Information | |
| Name | Kadejah Croskey |
| Applicant Email Address | Email hidden; Javascript is required. |
| Unique Identifier | 01871200116 |
| Payment Type | Short-Term Hotel/Motel Stays |
| Payment Details | |
| Receipt Amount | $1,308.10 |
| Receipt Date | 06/30/2022 |
| Comments | extended stay at Super 8 |
| Staff Name | Gloria Jimenez |
| Case Manager | CC |
| Verifier Name | Gloria Jimenez |
| Verifier Signature | |
| Date Verified | 06/30/2022 |
