| Payment ID | 29459 |
|---|---|
| Date Created | 06/15/23 10:26 am |
| Created By | Gloria Jimenez |
| Service Request | 29305 |
| Application ID | 22813 |
| Authorization Number | 221959 |
| Applicant Information | |
| Name | Tarshia Mckinney |
| Applicant Email Address | Email hidden; Javascript is required. |
| Unique Identifier | 16170701531 |
| Payment Type | Short-Term Hotel/Motel Stays |
| Type of Service Request | Hotel Stay |
| Location | Studio 6 |
| Location Contact Name | Sanjay |
| Location Email Address | Email hidden; Javascript is required. |
| Start Day | Monday |
| Guests | 3 |
| From | 06/14/2023 |
| To | 06/21/2023 |
| Days | 7 |
| Payment Details | |
| Payment Amount | $800.00 |
| Receipt Amount | $1,924.07 |
| Receipt Date | 06/14/2023 |
| Comments | hotel stay at Studio 6 from 06/01/23 departure date is 06/21/23. this payment includes more than one service request |
| Receipt | 29459-Mckinney.pdf |
| Staff Name | Gloria Jimenez |
| Case Manager | BJ |
| Case Worker Email | Email hidden; Javascript is required. |
| Verifier Name | Gloria Jimenez |
| Verifier Signature | |
| Date Verified | 06/15/2023 |
