| Payment ID | 8013 |
|---|---|
| Date Created | 09/13/22 9:49 am |
| 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 | $157.53 |
| Receipt Date | 09/12/2022 |
| Comments | extended stay at Studio 6 from 9/12/2022 through 9/14/2022 |
| Receipt | 8013-Smith.pdf |
| Staff Name | Gloria Jimenez |
| Case Manager | AL |
| Verifier Name | Gloria Jimenez |
| Verifier Signature | |
| Date Verified | 09/13/2022 |
