| Payment ID | 5049 |
|---|---|
| Date Created | 08/02/22 4:24 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 | $604.78 |
| Receipt Date | 07/18/2022 |
| Comments | hotel extended stay at Super 8 |
| Receipt | 18-07-2022Croskey604.78.pdf |
| Staff Name | Gloria Jimenez |
| Case Manager | CC |
| Verifier Name | Gloria Jimenez |
| Verifier Signature | |
| Date Verified | 08/02/2022 |
