| Payment ID | 99368 |
|---|---|
| Date Created | 03/28/25 12:10 pm |
| Created By | Gloria Jimenez |
| Service Request | 99292 |
| Application ID | 70352 |
| Authorization Number | 225558 |
| Applicant Information | |
| Name | Artissa Washington |
| Applicant Email Address | Email hidden; Javascript is required. |
| Unique Identifier | 16170503440 |
| 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 | 03/01/2025 |
| To | 03/03/2025 |
| Days | 2 |
| Payment Details | |
| Payment Amount | $125.99 |
| Receipt Amount | $125.99 |
| Receipt Date | 03/05/2025 |
| Comments | hotel stay |
| Receipt | |
| Staff Name | Gloria Jimenez |
| Case Manager | LRE |
| Case Worker Email | Email hidden; Javascript is required. |
| Verifier Name | Gloria Jimenez |
| Verifier Signature | |
| Date Verified | 03/28/2025 |
