| Payment ID | 24243 |
|---|---|
| Date Created | 04/26/23 2:53 pm |
| Created By | Gloria Jimenez |
| Service Request | 23947 |
| Application ID | 20096 |
| Authorization Number | |
| Applicant Information | |
| Name | Ann Rodriguez |
| Applicant Email Address | Email hidden; Javascript is required. |
| Unique Identifier | 07422701407 |
| 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 | 04/26/2023 |
| To | 05/03/2023 |
| Days | 7 |
| Address of Client Unit | Texas Map It |
| Address for Payment | Texas Map It |
| Address of Client Unit | Texas Map It |
| Address for Payment | Texas Map It |
| Address | Texas Map It |
| Address of Client Unit | Texas Map It |
| Address for Payment | Texas Map It |
| Move From Address | Texas Map It |
| Move To Address | Texas Map It |
| Address | Texas Map It |
| Payment Details | |
| Payment Amount | $800.00 |
| Receipt Amount | $1,175.12 |
| Receipt Date | 04/25/2023 |
| Comments | hotel stay at Woodsprings departure date is 05/03/23 |
| Receipt | 25-04-2023Rodriguez1098.39.pdf |
| Staff Name | Gloria Jimenez |
| Case Manager | BJ |
| Case Worker Email | Email hidden; Javascript is required. |
| Verifier Name | Gloria Jimenez |
| Verifier Signature | |
| Date Verified | 04/26/2023 |
