| Payment ID | 48059 |
|---|---|
| Date Created | 12/11/23 4:37 pm |
| Created By | Gloria Jimenez |
| Service Request | 47819 |
| Application ID | 46791 |
| Authorization Number | 223059 |
| Applicant Information | |
| Name | Valerie Hernandez |
| Applicant Email Address | Email hidden; Javascript is required. |
| Unique Identifier | 16170802689 |
| 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 | 6 |
| From | 12/12/2023 |
| To | 12/20/2023 |
| Days | 8 |
| Payment Details | |
| Payment Amount | $800.00 |
| Receipt Amount | $800.00 |
| Receipt Date | 12/11/2023 |
| Comments | hotel stay at Studio 6 departure date is 12/20/23 |
| Receipt | 48059-Hernandez.pdf |
| Staff Name | Gloria |
| Case Manager | DG |
| Case Worker Email | Email hidden; Javascript is required. |
| Verifier Name | Gloria Jimenez |
| Verifier Signature | |
| Date Verified | 12/11/2023 |
