| Payment ID | 33875 |
|---|---|
| Date Created | 07/18/23 2:46 pm |
| Created By | Gloria Jimenez |
| Service Request | 32501 |
| Application ID | 29516 |
| Authorization Number | 222166 |
| Applicant Information | |
| Name | Vera Castillo |
| Applicant Email Address | Email hidden; Javascript is required. |
| Unique Identifier | 16170701869 |
| 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 | Thursday |
| Guests | 5 |
| From | 07/15/2023 |
| To | 07/22/2023 |
| Days | 7 |
| Payment Details | |
| Payment Amount | $800.00 |
| Receipt Amount | $619.85 |
| Receipt Date | 07/12/2023 |
| Comments | hotel stay at extended stay from 07/12/23 through 07/19/23 |
| Receipt | 33875-Castillo.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 |
