| Payment ID | 761 |
|---|---|
| Date Created | 05/20/22 3:05 pm |
| Created By | Yoli |
| Service Request | |
| Application ID | 366 |
| Authorization Number | |
| Applicant Information | |
| Name | Teresa King |
| Agency Name | Unknown |
| Unique Identifier | 16171100038 |
| Payment Type | Short-Term Hotel/Motel Stays |
| Payment Details | |
| Receipt Amount | $1,702.49 |
| Receipt Date | 05/16/2022 |
| Receipt | 761-King.pdf |
| Staff Name | Yolanda Salazar |
| Staff Signature | |
| Verifier Name | Melvin Collins Jr |
| Verifier Signature | |
| Date Verified | 05/16/2022 |
