| Payment ID | 4904 |
|---|---|
| Date Created | 07/31/22 12:45 pm |
| Created By | Gloria Jimenez |
| Service Request | |
| Application ID | 1549 |
| Authorization Number | |
| Applicant Information | |
| Name | Markikia White |
| Applicant Email Address | Email hidden; Javascript is required. |
| Unique Identifier | 16171000163 |
| Payment Type | Short-Term Hotel/Motel Stays |
| Payment Details | |
| Receipt Amount | $553.00 |
| Receipt Date | 07/27/2022 |
| Comments | hotel extended stay departure date is 8/3/22 |
| Staff Name | Gloria Jimenez |
| Case Manager | BP |
| Verifier Name | Gloria Jimenez |
| Verifier Signature | |
| Date Verified | 07/31/2022 |
