| Payment ID | 7040 |
|---|---|
| Date Created | 08/29/22 2:02 pm |
| Created By | Gloria Jimenez |
| Service Request | |
| Application ID | 2762 |
| Authorization Number | |
| Applicant Information | |
| Name | Shemell Smith |
| Applicant Email Address | Email hidden; Javascript is required. |
| Unique Identifier | 16170700261 |
| Payment Type | Short-Term Hotel/Motel Stays |
| Payment Details | |
| Receipt Amount | $491.05 |
| Receipt Date | 08/25/2022 |
| Comments | extended stay at Studio 6 departure date is 8/31/2022 |
| Receipt | 7040-Smith.pdf |
| Staff Name | Gloria Jimenez |
| Case Manager | AL |
| Verifier Name | Gloria Jimenez |
| Verifier Signature | |
| Date Verified | 08/29/2022 |
