| Payment ID | 99007 |
|---|---|
| Date Created | 03/26/25 10:37 am |
| Created By | Gloria Jimenez |
| Service Request | 94677 |
| Application ID | 81138 |
| Authorization Number | 225181 |
| 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 | 02/26/2025 |
| To | 03/05/2025 |
| Days | 7 |
| Payment Details | |
| Payment Amount | $500.00 |
| Receipt Amount | -$220.97 |
| Receipt Date | 03/01/2025 |
| Comments | refund, client checked out |
| Receipt | |
| Staff Name | Gloria Jimenez |
| Case Manager | SJ |
| Case Worker Email | Email hidden; Javascript is required. |
| Verifier Name | Gloria Jimenez |
| Verifier Signature | |
| Date Verified | 03/26/2025 |
