| Payment ID | 20351 |
|---|---|
| Date Created | 03/21/23 3:05 pm |
| Created By | Gloria Jimenez |
| Service Request | 20173 |
| Application ID | 14420 |
| Authorization Number | |
| Applicant Information | |
| Name | Tyrone Mitchell |
| Applicant Email Address | Email hidden; Javascript is required. |
| Unique Identifier | 16170701094 |
| Payment Type | Short-Term Hotel/Motel Stays |
| Type of Service Request | Hotel Stay |
| Location | Studio 6 |
| Location Contact Name | Sanjay |
| Location Email Address | Email hidden; Javascript is required. |
| Start Day | Monday |
| Guests | 3 |
| From | 03/20/2023 |
| To | 03/27/2023 |
| Days | 7 |
| Payment Details | |
| Payment Amount | $160.98 |
| Receipt Amount | $160.98 |
| Receipt Date | 03/20/2023 |
| Comments | hotel stay at Studio 6 for 03/27/23 through 03/29/23 |
| Receipt | 20-03-2023Mitchell160.98.pdf |
| Staff Name | Gloria Jimenez |
| Case Manager | BJ |
| Case Worker Email | Email hidden; Javascript is required. |
| Verifier Name | Gloria Jimenez |
| Verifier Signature | |
| Date Verified | 03/21/2023 |
