| Payment ID | 7971 |
|---|---|
| Date Created | 09/12/22 4:24 pm |
| Created By | Gloria Jimenez |
| Service Request | |
| Application ID | 5777 |
| Authorization Number | |
| Applicant Information | |
| Name | Latisha Payne |
| Applicant Email Address | Email hidden; Javascript is required. |
| Unique Identifier | 70800536 |
| Payment Type | Short-Term Hotel/Motel Stays |
| Payment Details | |
| Receipt Amount | $691.11 |
| Receipt Date | 09/12/2022 |
| Comments | hotel stay at Super 8 arrival date 9/9/22 through 9/16/22 |
| Receipt | 7971-Payne.pdf |
| Staff Name | Gloria Jimenez |
| Case Manager | LRE |
| Verifier Name | Gloria Jimenez |
| Verifier Signature | |
| Date Verified | 09/12/2022 |
