| Payment ID | 20195 |
|---|---|
| Date Created | 03/20/23 9:24 am |
| Created By | Gloria Jimenez |
| Service Request | 19852 |
| Application ID | 17225 |
| Authorization Number | |
| Applicant Information | |
| Name | Alexis Lee |
| Applicant Email Address | Email hidden; Javascript is required. |
| Unique Identifier | 16170401277 |
| Payment Type | Short-Term Hotel/Motel Stays |
| Type of Service Request | Hotel Stay |
| Location | Woodspring Suites |
| Location Contact Name | Everesta |
| Location Email Address | Email hidden; Javascript is required. |
| Start Day | Monday |
| Guests | 1 |
| From | 03/15/2023 |
| To | 03/22/2023 |
| Days | 7 |
| Payment Details | |
| Payment Amount | $451.01 |
| Receipt Amount | $451.01 |
| Receipt Date | 03/17/2023 |
| Comments | hotel stay at Woodspring departure date is 03/29/23 |
| Receipt | 17-03-2023Lee451.01.pdf |
| Staff Name | Gloria Jimenez |
| Case Manager | LRE |
| Case Worker Email | Email hidden; Javascript is required. |
| Verifier Name | Gloria Jimenez |
| Verifier Signature | |
| Date Verified | 03/20/2023 |
