| Payment ID | 52552 |
|---|---|
| Date Created | 01/17/24 4:43 pm |
| Created By | Gloria Jimenez |
| Service Request | 52367 |
| Application ID | 45631 |
| Authorization Number | 223220 |
| Applicant Information | |
| Name | Taura Henderson |
| Applicant Email Address | Email hidden; Javascript is required. |
| Unique Identifier | 16171102649 |
| 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 | Thursday |
| Guests | 2 |
| From | 01/18/2024 |
| To | 01/25/2024 |
| Days | 7 |
| Payment Details | |
| Payment Amount | $623.00 |
| Receipt Amount | $623.00 |
| Receipt Date | 01/17/2024 |
| Comments | hotel stay at Studio 6 departure date is 01/24/24 |
| Receipt | 52552-Henderson.pdf |
| Staff Name | Gloria |
| Case Manager | CM |
| Case Worker Email | Email hidden; Javascript is required. |
| Verifier Name | Gloria Jimenez |
| Verifier Signature | |
| Date Verified | 01/17/2024 |
