| Payment ID | 29220 |
|---|---|
| Date Created | 06/13/23 3:31 pm |
| Created By | Gloria Jimenez |
| Service Request | 27991 |
| Application ID | 20268 |
| Authorization Number | 221895 |
| Applicant Information | |
| Name | Quinntavia Witherspoon |
| Applicant Email Address | Email hidden; Javascript is required. |
| Unique Identifier | 16171001412 |
| Payment Type | Short-Term Hotel/Motel Stays |
| Type of Service Request | Hotel Stay |
| Location | Extended Stay |
| Location Contact Name | Vanya |
| Location Email Address | Email hidden; Javascript is required. |
| Start Day | Monday |
| Guests | 2 |
| From | 06/07/2023 |
| To | 06/14/2023 |
| Days | 7 |
| Payment Details | |
| Payment Amount | $822.90 |
| Receipt Amount | $759.60 |
| Receipt Date | 06/06/2023 |
| Comments | hotel stay at Extended Stay departure stay is 06/12/23 |
| Receipt | 29220-Witherspoon.pdf |
| Staff Name | Gloria Jimenez |
| Case Manager | DG |
| Case Worker Email | Email hidden; Javascript is required. |
| Verifier Name | Gloria Jimenez |
| Verifier Signature | |
| Date Verified | 06/13/2023 |
