| Payment ID | 4895 |
|---|---|
| Date Created | 07/31/22 12:24 pm |
| Created By | Gloria Jimenez |
| Service Request | |
| Application ID | 4067 |
| Authorization Number | |
| Applicant Information | |
| Name | Mykelti Castleberry |
| Applicant Email Address | Email hidden; Javascript is required. |
| Unique Identifier | 16171000381 |
| Payment Type | Short-Term Hotel/Motel Stays |
| Payment Details | |
| Receipt Amount | $1,300.00 |
| Receipt Date | 07/26/2022 |
| Comments | hotel stay robinson inn suites for the Sandman arrival 7/26 through 8/30 |
| Receipt | 4895-Castleberry.pdf |
| Staff Name | Gloria Jimenez |
| Case Manager | DG |
| Verifier Name | Gloria Jimenez |
| Verifier Signature | |
| Date Verified | 07/31/2022 |
