| Payment ID | 4560 |
|---|---|
| Date Created | 07/26/22 2:19 pm |
| Created By | Gloria Jimenez |
| Service Request | |
| Application ID | 3085 |
| Authorization Number | |
| Applicant Information | |
| Name | Atayziya Smith |
| Applicant Email Address | Email hidden; Javascript is required. |
| Unique Identifier | 16170700297 |
| Payment Type | Short-Term Hotel/Motel Stays |
| Payment Details | |
| Receipt Amount | $1,382.22 |
| Receipt Date | 07/25/2022 |
| Comments | hotel stay at Super 8 arrival date 7/25 |
| Receipt | 25-07-2022Smith1382.22.pdf |
| Staff Name | Gloria Jimenez |
| Case Manager | BP |
| Verifier Name | Gloria Jimenez |
| Verifier Signature | |
| Date Verified | 07/26/2022 |
