| Payment ID | 8146 |
|---|---|
| Date Created | 09/14/22 4:33 pm |
| Created By | Gloria Jimenez |
| Service Request | |
| Application ID | 7101 |
| Authorization Number | |
| Applicant Information | |
| Name | Khimarye Hickman |
| Applicant Email Address | Email hidden; Javascript is required. |
| Unique Identifier | 16170700595 |
| Payment Type | Short-Term Hotel/Motel Stays |
| Payment Details | |
| Receipt Amount | $89.00 |
| Receipt Date | 09/14/2022 |
| Comments | hotel stay paid for one night at Super 8 |
| Receipt | 8146-Hickman.pdf |
| Staff Name | Gloria Jimenez |
| Case Manager | LRE |
| Verifier Name | Gloria Jimenez |
| Verifier Signature | |
| Date Verified | 09/14/2022 |
