| Payment ID | 8709 |
|---|---|
| Date Created | 09/26/22 11:59 am |
| Created By | Gloria Jimenez |
| Service Request | |
| Application ID | 4646 |
| Authorization Number | |
| Applicant Information | |
| Name | Shapasshun Brooks |
| Applicant Email Address | Email hidden; Javascript is required. |
| Unique Identifier | 16160500431 |
| Payment Type | Short-Term Hotel/Motel Stays |
| Payment Details | |
| Receipt Amount | $1,451.40 |
| Receipt Date | 09/22/2022 |
| Comments | hotel stay at extended stay |
| Receipt | 8709-Brooks.pdf |
| Staff Name | Gloria Jimenez |
| Case Manager | DG |
| Verifier Name | Gloria Jimenez |
| Verifier Signature | |
| Date Verified | 09/26/2022 |
