| Payment ID | 21395 |
|---|---|
| Date Created | 03/31/23 3:41 pm |
| Created By | Rick Jaimes |
| Service Request | 21318 |
| Application ID | 19804 |
| Authorization Number | |
| Applicant Information | |
| Name | LINDA Charanza |
| Applicant Email Address | Email hidden; Javascript is required. |
| Unique Identifier | 16170501391 |
| 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 | 2 |
| From | 03/30/2023 |
| To | 04/13/2023 |
| Days | 14 |
| Payment Details | |
| Payment Amount | $1,280.00 |
| Receipt Amount | $1,280.00 |
| Receipt Date | 03/30/2023 |
| Comments | Hotel Stay at Studio 6 Departure date:4/13/23 |
| Receipt | 30-03-2023Charanza1280.00.pdf |
| Staff Name | Rick Jaimes |
| Case Manager | DJ |
| Case Worker Email | Email hidden; Javascript is required. |
| Verifier Name | Rick Jaimes |
| Verifier Signature | |
| Date Verified | 03/31/2023 |
