| Payment ID | 97621 |
|---|---|
| Date Created | 03/17/25 1:07 pm |
| Created By | Gloria Jimenez |
| Service Request | 96661 |
| Application ID | 47061 |
| Authorization Number | 225358 |
| Applicant Information | |
| Name | Latressa Green |
| Applicant Email Address | Email hidden; Javascript is required. |
| Unique Identifier | 16170802695 |
| Payment Type | Short-Term Hotel/Motel Stays |
| Type of Service Request | Hotel Stay |
| Location | Candlewood Suites |
| Location Contact Name | Sales |
| Location Email Address | Email hidden; Javascript is required. |
| Start Day | Monday |
| Guests | 4 |
| From | 03/12/2025 |
| To | 03/19/2025 |
| Days | 7 |
| Payment Details | |
| Payment Amount | $606.90 |
| Receipt Amount | $734.35 |
| Receipt Date | 03/14/2025 |
| Comments | payment to Candlewood paid up to 03/19/25 |
| Receipt | 97621-Green.pdf |
| Staff Name | Gloria Jimenez |
| Case Manager | DJ |
| Case Worker Email | Email hidden; Javascript is required. |
| Verifier Name | Gloria Jimenez |
| Verifier Signature | |
| Date Verified | 03/17/2025 |
