| Payment ID | 61273 |
|---|---|
| Date Created | 03/11/24 12:27 pm |
| Created By | Gloria Jimenez |
| Service Request | 60561 |
| Application ID | 53027 |
| Authorization Number | 223622 |
| Applicant Information | |
| Name | Lauren Powers |
| Applicant Email Address | Email hidden; Javascript is required. |
| Unique Identifier | 16170702864 |
| 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 | 1 |
| From | 03/06/2024 |
| To | 03/13/2024 |
| Days | 7 |
| Payment Details | |
| Payment Amount | $680.00 |
| Receipt Amount | $2,693.00 |
| Receipt Date | 03/07/2024 |
| Comments | payment made to Studio 6 departure date is 03/13/24, this payment includes more than one service request |
| Receipt | 61273-Powers.pdf |
| Staff Name | Gloria |
| Case Manager | DL |
| Case Worker Email | Email hidden; Javascript is required. |
| Verifier Name | Gloria Jimenez |
| Verifier Signature | |
| Date Verified | 03/11/2024 |
