| Payment ID | 33724 |
|---|---|
| Date Created | 07/18/23 10:45 am |
| Created By | Gloria Jimenez |
| Service Request | 33402 |
| Application ID | 26332 |
| Authorization Number | 222236 |
| Applicant Information | |
| Name | Shavon Bessie |
| Applicant Email Address | Email hidden; Javascript is required. |
| Unique Identifier | 16171001694 |
| 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 | 07/17/2023 |
| To | 07/24/2023 |
| Days | 7 |
| Payment Details | |
| Payment Amount | $750.00 |
| Receipt Amount | $693.45 |
| Receipt Date | 07/17/2023 |
| Comments | hotel stay at Extended Stay departure date is 07/26/23 |
| Receipt | 33724-Bessie.pdf |
| Staff Name | Gloria Jimenez |
| Case Manager | LRE |
| Case Worker Email | Email hidden; Javascript is required. |
| Verifier Name | Gloria Jimenez |
| Verifier Signature | |
| Date Verified | 07/18/2023 |
