| Payment ID | 755 |
|---|---|
| Date Created | 05/20/22 2:10 pm |
| Created By | Yoli |
| Service Request | |
| Application ID | 640 |
| Authorization Number | |
| Applicant Information | |
| Name | Lamarcus Gay |
| Unique Identifier | 16170400097 |
| Payment Type | Short-Term Hotel/Motel Stays |
| Payment Details | |
| Receipt Amount | $2,716.06 |
| Receipt Date | 05/20/2022 |
| Receipt | 755-Gay.pdf |
| Staff Name | Yolanda Salazar |
| Staff Signature | |
| Verifier Name | Melvin Collins Jr |
| Verifier Signature | |
| Date Verified | 05/20/2022 |
