| Payment ID | 8023 |
|---|---|
| Date Created | 09/13/22 10:54 am |
| Created By | Gloria Jimenez |
| Service Request | |
| Application ID | 5207 |
| Authorization Number | |
| Applicant Information | |
| Name | Shakeri Hicks |
| Applicant Email Address | Email hidden; Javascript is required. |
| Unique Identifier | 16170400476 |
| Payment Type | Short-Term Hotel/Motel Stays |
| Payment Details | |
| Receipt Amount | $414.67 |
| Receipt Date | 09/12/2022 |
| Comments | hotel stay at Woodspring arrival 9/09/2022 departure date is 10/01/2022. next payment is due 9/14/2022 |
| Receipt | 8023-Hicks.pdf |
| Staff Name | Gloria Jimenez |
| Case Manager | BJ |
| Verifier Name | Gloria Jimenez |
| Verifier Signature | |
| Date Verified | 09/13/2022 |
