| Payment ID | 6156 |
|---|---|
| Date Created | 08/18/22 1:41 pm |
| Created By | Gloria Jimenez |
| Service Request | |
| Application ID | 4176 |
| Authorization Number | |
| Applicant Information | |
| Name | Tynicca Davis |
| Applicant Email Address | Email hidden; Javascript is required. |
| Unique Identifier | 16170800401 |
| Payment Type | Short-Term Hotel/Motel Stays |
| Payment Details | |
| Receipt Amount | $503.64 |
| Receipt Date | 08/09/2022 |
| Comments | motel stay paid 1 week at Motel 6 |
| Receipt | 6156-Davis.pdf |
| Staff Name | Gloria Jimenez |
| Case Manager | AL |
| Verifier Name | Gloria Jimenez |
| Verifier Signature | |
| Date Verified | 08/18/2022 |
