| Payment ID | 26341 |
|---|---|
| Date Created | 05/18/23 2:38 pm |
| Created By | Gloria Jimenez |
| Service Request | 20881 |
| Application ID | 15133 |
| Authorization Number | |
| Applicant Information | |
| Name | Gabrielle Diaz |
| Applicant Email Address | Email hidden; Javascript is required. |
| Unique Identifier | 16165701143 |
| 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 | 4 |
| From | 03/28/2023 |
| To | 04/04/2023 |
| Days | 7 |
| Payment Details | |
| Payment Amount | $800.00 |
| Receipt Amount | $474.04 |
| Receipt Date | 05/01/2023 |
| Comments | payment to Woodsprings |
| Receipt | 26341-Diaz.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 |
