| Payment ID | 51712 |
|---|---|
| Date Created | 01/10/24 3:04 pm |
| Created By | Gloria Jimenez |
| Service Request | 49511 |
| Application ID | 41586 |
| Authorization Number | 223137 |
| Applicant Information | |
| Name | Olivia Zambrano |
| Applicant Email Address | Email hidden; Javascript is required. |
| Unique Identifier | 16152802460 |
| 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 | 2 |
| From | 01/03/2024 |
| To | 01/10/2024 |
| Days | 7 |
| Payment Details | |
| Payment Amount | $800.00 |
| Receipt Amount | $800.10 |
| Receipt Date | 01/09/2024 |
| Comments | hotel stay at Studio 6 departure date is 01/10/23 |
| Receipt | 51712-Zambrano.pdf |
| Staff Name | Gloria |
| Case Manager | BJ |
| Case Worker Email | Email hidden; Javascript is required. |
| Verifier Name | Gloria Jimenez |
| Verifier Signature | |
| Date Verified | 01/10/2024 |
