| Payment ID | 26303 |
|---|---|
| Date Created | 05/18/23 11:40 am |
| Created By | Gloria Jimenez |
| Service Request | 24999 |
| Application ID | 23519 |
| Authorization Number | |
| Applicant Information | |
| Name | Justin Berry |
| Applicant Email Address | Email hidden; Javascript is required. |
| Unique Identifier | 16101566 |
| 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 | 05/08/2023 |
| To | 05/24/2023 |
| Days | 16 |
| Payment Details | |
| Payment Amount | $1,200.00 |
| Receipt Amount | $690.57 |
| Receipt Date | 05/16/2023 |
| Comments | payment made to Woodsprings departure date 05/24/23 |
| Receipt | 26303-Berry.pdf |
| Staff Name | Gloria Jimenez |
| Case Manager | BJ |
| Case Worker Email | Email hidden; Javascript is required. |
| Verifier Name | Gloria Jimenez |
| Verifier Signature | |
| Date Verified | 05/18/2023 |
