| Payment ID | 36308 |
|---|---|
| Date Created | 08/07/23 12:54 pm |
| Created By | Gloria Jimenez |
| Service Request | 31641 |
| Application ID | 24773 |
| Authorization Number | 222128 |
| Applicant Information | |
| Name | Alexandra Barajas |
| Applicant Email Address | Email hidden; Javascript is required. |
| Unique Identifier | 11064501610 |
| Payment Type | Short-Term Hotel/Motel Stays |
| Type of Service Request | Hotel Stay |
| Location | Super 8 Hillsboro |
| Location Contact Name | Manager |
| Location Email Address | Email hidden; Javascript is required. |
| Start Day | Monday |
| Guests | 4 |
| From | 07/10/2023 |
| To | 07/17/2023 |
| Days | 7 |
| Payment Details | |
| Payment Amount | $475.00 |
| Receipt Amount | $74.53 |
| Receipt Date | 08/02/2023 |
| Comments | hotel stay at Super 8 by Wyndom in Hillsboro |
| Receipt | |
| Staff Name | Gloria Jimenez |
| Case Manager | BP |
| Case Worker Email | Email hidden; Javascript is required. |
| Verifier Name | Gloria Jimenez |
| Verifier Signature | |
| Date Verified | 08/07/2023 |
