| Payment ID | 33782 |
|---|---|
| Date Created | 07/18/23 12:13 pm |
| Created By | Gloria Jimenez |
| Service Request | 32715 |
| Application ID | 20938 |
| Authorization Number | 222199 |
| Applicant Information | |
| Name | Andrea Casper-Poehls |
| Applicant Email Address | Email hidden; Javascript is required. |
| Unique Identifier | 16171101440 |
| 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 | 1 |
| From | 07/12/2023 |
| To | 07/19/2023 |
| Days | 7 |
| Payment Details | |
| Payment Amount | $800.00 |
| Receipt Amount | $551.94 |
| Receipt Date | 07/12/2023 |
| Comments | hotel stay at Studio 6 departure date is 07/19/23 |
| Receipt | 33782-Casper-Poehls.pdf |
| Staff Name | Gloria Jimenez |
| Case Manager | BJ |
| Case Worker Email | Email hidden; Javascript is required. |
| Verifier Name | Gloria Jimenez |
| Verifier Signature | |
| Date Verified | 07/18/2023 |
