| Payment ID | 89217 |
|---|---|
| Date Created | 01/23/25 3:26 pm |
| Created By | Gloria Jimenez |
| Service Request | 88332 |
| Application ID | 81138 |
| Authorization Number | 224737 |
| Applicant Information | |
| Name | marquita flowers |
| Applicant Email Address | Email hidden; Javascript is required. |
| Unique Identifier | 16171003766 |
| 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 | 4 |
| From | 01/22/2025 |
| To | 01/29/2025 |
| Days | 7 |
| Payment Details | |
| Payment Amount | $500.01 |
| Receipt Amount | $1,566.25 |
| Receipt Date | 01/22/2025 |
| Comments | hotel stay at Studio 6 departure date is 01/29/25, this payment includes more than one service request |
| Receipt | 89217-flowers.pdf |
| Staff Name | Gloria Jimenez |
| Case Manager | BJ |
| Case Worker Email | Email hidden; Javascript is required. |
| Verifier Name | Gloria Jimenez |
| Verifier Signature | |
| Date Verified | 01/23/2025 |
