| Payment ID | 26331 |
|---|---|
| Date Created | 05/18/23 2:07 pm |
| Created By | Gloria Jimenez |
| Service Request | 25345 |
| Application ID | 21173 |
| Authorization Number | |
| Applicant Information | |
| Name | Melissa Eversole |
| Applicant Email Address | Email hidden; Javascript is required. |
| Unique Identifier | 16164001462 |
| 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 | 05/10/2023 |
| To | 05/17/2023 |
| Days | 7 |
| Payment Details | |
| Payment Amount | $750.00 |
| Receipt Amount | $256.64 |
| Receipt Date | 05/16/2023 |
| Comments | payment to Woodsprings departure date 05/17/23 |
| Receipt | 26331-Eversole.pdf |
| Staff Name | Gloria Jimenez |
| Case Manager | LRE |
| Case Worker Email | Email hidden; Javascript is required. |
| Verifier Name | Gloria Jimenez |
| Verifier Signature | |
| Date Verified | 05/18/2023 |
