| Payment ID | 23378 |
|---|---|
| Date Created | 04/20/23 12:47 pm |
| Created By | Gloria Jimenez |
| Service Request | 22849 |
| Application ID | 18771 |
| Authorization Number | |
| Applicant Information | |
| Name | Stephen Behringer |
| Applicant Email Address | Email hidden; Javascript is required. |
| Unique Identifier | 16170801342 |
| 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 | 1 |
| From | 04/17/2023 |
| To | 04/24/2023 |
| Days | 7 |
| Payment Details | |
| Payment Amount | $550.00 |
| Receipt Amount | $685.91 |
| Receipt Date | 04/18/2023 |
| Comments | hotel stay at Studio 6 departure date is 04/26/23 |
| Receipt | 18-04-2023Behringer685.91.pdf |
| Staff Name | Gloria Jimenez |
| Case Manager | DL |
| Case Worker Email | Email hidden; Javascript is required. |
| Verifier Name | Gloria Jimenez |
| Verifier Signature | |
| Date Verified | 04/20/2023 |
