| Payment ID | 7955 |
|---|---|
| Date Created | 09/12/22 3:18 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 | $350.75 |
| Receipt Date | 09/06/2022 |
| Comments | extended stay at Motel 6 from 9/7/22 through 9/12/22 |
| Receipt | 7955-Smith.pdf |
| Staff Name | Gloria Jimenez |
| Case Manager | AL |
| Verifier Name | Gloria Jimenez |
| Verifier Signature | |
| Date Verified | 09/12/2022 |
