| Payment ID | 95080 |
|---|---|
| Date Created | 02/25/25 1:46 pm |
| Created By | Gloria Jimenez |
| Service Request | 93868 |
| Application ID | 86265 |
| Authorization Number | 225118 |
| Applicant Information | |
| Name | Mark Mendez |
| Applicant Email Address | Email hidden; Javascript is required. |
| Unique Identifier | 16170504200 |
| Payment Type | Short-Term Hotel/Motel Stays |
| Type of Service Request | Hotel Stay |
| Location | Delta Inn |
| Start Day | Monday |
| Guests | 2 |
| From | 02/21/2025 |
| To | 02/26/2025 |
| Days | 5 |
| Payment Details | |
| Payment Amount | $357.15 |
| Receipt Amount | $332.35 |
| Receipt Date | 02/21/2025 |
| Comments | hotel stay at the Delta with spouse Vanessa Macias departure date is 02/28/25 |
| Receipt | |
| Staff Name | Gloria Jimenez |
| Case Manager | SJ |
| Case Worker Email | Email hidden; Javascript is required. |
| Verifier Name | Gloria Jimenez |
| Verifier Signature | |
| Date Verified | 02/25/2025 |
