| Payment ID | 5559 |
|---|---|
| Date Created | 08/11/22 1:18 pm |
| Created By | Gloria Jimenez |
| Service Request | |
| Application ID | 3716 |
| Authorization Number | |
| Applicant Information | |
| Name | Shawnequa Edwards |
| Applicant Email Address | Email hidden; Javascript is required. |
| Unique Identifier | 16170400354 |
| Payment Type | Short-Term Hotel/Motel Stays |
| Payment Details | |
| Receipt Amount | $536.34 |
| Receipt Date | 08/10/2022 |
| Comments | hotel stay at extended stay America departure date is 8/16/2022 |
| Receipt | 5559-Edwards.pdf |
| Staff Name | Gloria Jimenez |
| Case Manager | DG |
| Verifier Name | Gloria Jimenez |
| Verifier Signature | |
| Date Verified | 08/11/2022 |
