| Payment ID | 92251 |
|---|---|
| Date Created | 02/10/25 11:12 am |
| Created By | Gloria Jimenez |
| Service Request | 89543 |
| Application ID | 85805 |
| Authorization Number | 224817 |
| Applicant Information | |
| Name | Britttany Dow |
| Applicant Email Address | Email hidden; Javascript is required. |
| Unique Identifier | 16170404186 |
| 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 | 01/29/2025 |
| To | 02/05/2025 |
| Days | 7 |
| Payment Details | |
| Payment Amount | $500.01 |
| Receipt Amount | $540.43 |
| Receipt Date | 02/06/2025 |
| Comments | hotel stay at studio 6 departure date is 02/05/25 |
| Receipt | 92251-Dow.pdf |
| Staff Name | Gloria Jimenez |
| Case Manager | BJ |
| Case Worker Email | Email hidden; Javascript is required. |
| Verifier Name | Gloria Jimenez |
| Verifier Signature | |
| Date Verified | 02/10/2025 |
