| Payment ID | 4529 |
|---|---|
| Date Created | 07/26/22 12:47 pm |
| Created By | Gloria Jimenez |
| Service Request | |
| Application ID | 2911 |
| Authorization Number | |
| Applicant Information | |
| Name | Tifarah Scott |
| Applicant Email Address | Email hidden; Javascript is required. |
| Unique Identifier | 16118100281 |
| Payment Type | Short-Term Hotel/Motel Stays |
| Payment Details | |
| Receipt Amount | $2,158.32 |
| Receipt Date | 07/25/2022 |
| Comments | hotel stay at Motel 6 starting 7/25/22 |
| Receipt | 25-07-2022Scott0.00.pdf |
| Staff Name | Gloria Jimenez |
| Case Manager | DG |
| Verifier Name | Gloria Jimenez |
| Verifier Signature | |
| Date Verified | 07/26/2022 |
