| Payment ID | 23227 |
|---|---|
| Date Created | 04/19/23 12:12 pm |
| Created By | Gloria Jimenez |
| Service Request | 22794 |
| Application ID | 18193 |
| Authorization Number | |
| Applicant Information | |
| Name | Amber Moore-Evans |
| Applicant Email Address | Email hidden; Javascript is required. |
| Unique Identifier | 16170501318 |
| 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 | Thursday |
| Guests | 2 |
| From | 04/14/2023 |
| To | 04/21/2023 |
| Days | 7 |
| Payment Details | |
| Payment Amount | $495.00 |
| Receipt Amount | $515.45 |
| Receipt Date | 04/13/2023 |
| Comments | hotel stay at Woodsprings departure date is 04/28/23 |
| Receipt | 13-04-2023Moore-Evans515.45.pdf |
| Staff Name | Gloria Jimenez |
| Case Manager | DG |
| Case Worker Email | Email hidden; Javascript is required. |
| Verifier Name | Gloria Jimenez |
| Verifier Signature | |
| Date Verified | 04/19/2023 |
