| Payment ID | 5579 |
|---|---|
| Date Created | 08/12/22 8:44 am |
| Created By | Gloria Jimenez |
| Service Request | |
| Application ID | 3450 |
| Authorization Number | |
| Applicant Information | |
| Name | katourah holt |
| Applicant Email Address | Email hidden; Javascript is required. |
| Unique Identifier | 16170600327 |
| Payment Type | Short-Term Hotel/Motel Stays |
| Payment Details | |
| Receipt Amount | $1,039.48 |
| Receipt Date | 08/04/2022 |
| Comments | extended stay at motel 6 for 8/4/2022 through 8/18/2022 |
| Receipt | 5579-holt.pdf |
| Staff Name | Gloria Jimenez |
| Case Manager | DG |
| Verifier Name | Gloria Jimenez |
| Verifier Signature | |
| Date Verified | 08/12/2022 |
