| Payment ID | 97623 |
|---|---|
| Date Created | 03/17/25 1:19 pm |
| Created By | Gloria Jimenez |
| Service Request | 96553 |
| Application ID | 83492 |
| Authorization Number | 225341 |
| Applicant Information | |
| Name | Lisa Montgomery |
| Applicant Email Address | Email hidden; Javascript is required. |
| Unique Identifier | 16170103996 |
| 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 | 03/10/2025 |
| To | 03/19/2025 |
| Days | 9 |
| Payment Details | |
| Payment Amount | $500.01 |
| Receipt Amount | $1,590.29 |
| Receipt Date | 03/14/2025 |
| Comments | payment to studio 6 departing 03/19/25 |
| Receipt | |
| Staff Name | Gloria Jimenez |
| Case Manager | SJ |
| Case Worker Email | Email hidden; Javascript is required. |
| Verifier Name | Gloria Jimenez |
| Verifier Signature | |
| Date Verified | 03/17/2025 |
