| Payment ID | 20382 |
|---|---|
| Date Created | 03/21/23 3:56 pm |
| Created By | Gloria Jimenez |
| Service Request | 20184 |
| Application ID | 17004 |
| Authorization Number | |
| Applicant Information | |
| Name | Ingram Boggess |
| Applicant Email Address | Email hidden; Javascript is required. |
| Unique Identifier | 16170601265 |
| 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 | 03/23/2023 |
| To | 03/30/2023 |
| Days | 7 |
| Payment Details | |
| Payment Amount | $451.02 |
| Receipt Amount | $451.02 |
| Receipt Date | 03/20/2023 |
| Comments | hotel stay at Woodsprings departure date is 03/30/23 |
| Receipt | 20-03-2023Boggess451.02.pdf |
| Staff Name | Gloria Jimenez |
| Case Manager | DJ |
| Case Worker Email | Email hidden; Javascript is required. |
| Verifier Name | Gloria Jimenez |
| Verifier Signature | |
| Date Verified | 03/21/2023 |
