| Payment ID | 23436 |
|---|---|
| Date Created | 04/20/23 3:18 pm |
| Created By | Gloria Jimenez |
| Service Request | 22251 |
| Application ID | 9741 |
| Authorization Number | |
| Applicant Information | |
| Name | Ashley Joiner |
| Applicant Email Address | Email hidden; Javascript is required. |
| Unique Identifier | 16170500811 |
| 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 | 5 |
| From | 04/14/2023 |
| To | 04/21/2023 |
| Days | 7 |
| Payment Details | |
| Payment Amount | $549.04 |
| Receipt Amount | $1,780.07 |
| Receipt Date | 04/14/2023 |
| Comments | hotel stay at Super 8 departure date is 04/19/23 |
| Receipt | 14-04-2023Joiner1780.07.pdf |
| Staff Name | Gloria Jimenez |
| Case Manager | DJ |
| Case Worker Email | Email hidden; Javascript is required. |
| Verifier Name | Gloria Jimenez |
| Verifier Signature | |
| Date Verified | 04/20/2023 |
