HomeMy WebLinkAboutGrant Related - BOCC (008)GRANT COUNTY
BOARD OF COUNTY COMMISSIONERS
1'I l �_1_1_.•�
To: Board of County Commissioners
From: Janice Flynn, Administrative Services Coordinator
Data June 14, 2023
Re: Authorization for Release of BOCC Approved Funds, Dept of Commerce,
CHG Grant #22-46108-10, Hotel Leasing Amendment, Reimbursement #25,
New Hope, Request #14
New Hope ,has requested reimbursement for the above -referenced grant, per the
contracted guidelines in the amount of $10,269.58 for May 2023 expenses. The invoice
and supporting documentation are attached for review.
am requesting the release of funds for payment to New Hope in the amount of
$10,269.58.
Thank you.
RECEIEIED
GRANT COLINTY COMMISSIONERS
Grantee Name: Grant County
Report Month/Year: May 2023
Lead Grantee
Grant County
New Hope
List Sub Grantee Names Below
Total
Feb -23 Mar -23 Apr -23 May -23 Jun -23 TOTAL OF BALANCE
REMAINING
$0.00 $0.00
$0.00 $0.00
$0.00 $0.00
$0.00 $0.00
$0.00 $0.00
r�o��i�.eascng�,Ktt1�►dh��lr��`� °�� �` $12,000.00 $1 064.00 833.63
$ $833.63 $1217.87
I 1
$9,000.00
$131.70
N a d� � •� S a` 4i L>�j p 1 ��,ga
T •Ot�IF�:;iea.7' �i3 r�'�� d `���` �`�`w+Tk� �+�U�' ��`wge `�Rr �`""'^��y�k )S �)e«�'�3d
$15,300.00 $964.99 $923.02 $659.40 $228.70
WA����_���;�� $45,000.00 $1,150.00 $4,453.10 $5,261.73
AdditionalGFundingwt°' 3"v�xyve s a $9� 412.00 $0.00 $0.00 $0.00 $0.00
Invoice Total; $3,178.99 $1,756.65 $5,946.13 $6,840.00
$90,712.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$12,017.72
-$17.72
$3,295.12
$3,426.82
$5,573.18
$2,857.37
$13,821.02
$1,478.98
$4,117.09
$39,713.58
$5,286.42
$0.00
$0.00 $0.00
$9,412.00
$10,269.58
$0.00 $68,979.14
$21,732.86
County of Grant
35 C ST NW
PA Box 37
Ephrata WA 98823
Vendor: KELLEY CONNECT CO
22710 72ND AVE S
KENT WA 08032
Number Purchase Order
T ----------
Document Number
Description,:
Copier 'Lease/Supplies
•
Page 11I
Invoice 0387858
Date 5/1/2023
Vendor lDppi I *Shi ng.Method P aym,ent Terms ID
Amou*nt
$270.92
Subtotal
$270.92
Misc
$0.,00
Tax
$0.00
Freight
$0.00
Trade Discount
$0.00
Payment
$0.00
Total Due
$270.92
KELLEY
CONNEC,-
Bill To: New Hope
Accounts Payable
311 3RD AVE
MOSES LAKE, WA 98837
us
!'711 1
CONTRACT INVOICE
Invoice Number:
Invoice Date:
Account Number:
Balance Due:
Customer** New Hope
311 31 'E
MOSES LAKE, WA 98837
IN1304576
4/25/2023
BIN3894
$210.92
A
me'v 'No T t. -Involco.TcUl . ....
_Du!�
Due
X -Days _- - -- ---- ----- _-5/25/202- 3-.---
aCtNU
con
:.Contad' t
Contract
ou umber Staqpate Ems,: Wte
N
$249.93
10/18/2019
10/17/2025
d'Rema
...........
Summary:
*9
$249-93
$249]3
Tax:
Contract, base rate charge for the 4/18/2023'to 5/1712023 billing period
Invoice Total
$270.92
Contract overage charge for the 1/18/2023 to 4/17/2023 overage period
$270,92
092
$ 1 40-38
Service Base Copier
$0.00
See overage details below
$109.55
$249.93
Detail:
Equipment Induded under his contract
Sharp/SHAMX3071
Number Serial Number
...... . Base Adj.
Locati
ion
813176 95082232 r . W."
$0.00
New Hope 3.11 3RD AVE
MOSES LAKE, WA 98837
KIDS HOPE
Meter Meter Group Win Meter End Meter
Total Covered
Billable Rate Ov'era'ge
Color COLOR 36,400 36,e9o0 --------
500 1.1500
0_ 0.053200 $0.00
B\W BW 16,700 lis,900
200 3t,500 -------
........ «.. ......
0 0.008500 $0.00
Estimated meter reading
$0.00
REMIT PAYMENT TO:
Kelley Connect
22710 72nd Ave S
Kent WA 98032
206-284-9100
Payment by credit card may be subject to a 3% surcharge.
To pay online,, visit our website: www.Kelleyconnect.com
Invoice SubTotal
*9
$249-93
$249]3
Tax:
$20.99
Invoice Total
$270.92
.8a ante Due*
$270,92
092
Page 1 of 1
1 18.76
County of Grant
35 C ST NW
P.O. Box 37
Ephrata WA 98823
Vendor-, KELLEY CONNECT CO
22710 72ND AVE S
KENT WA 98032
Document Number ..Purchase Order Number
IN 1304617
Descriptil
. n ow
Copier Lease/Supplies
Page 111
Invoice 0387859
Date 5/1/2023
VendorlD I ------ -, - —
Shipping Meth1w Payment Terms ID
Amount
$i.,071.28
Subtotal
.... ......
0071.28
Mise
$0.00
Tax
$0.00
Freight
$0.00
Trade Discount
$0.00
Payment
$0,00
Total Due
$1;071.28
'-J'vELLEY
CONNEG.
81*11 To: New Hope
Accounts Payable
311 3RD AVE
MOSES LAKE, WA 98837
us
EPRO-VE'
L4 Invoice Number: IN1304617
Invoice Date: 4/25/2023
Account. Number: BIN3894
Due, Balance Due, $1,,071.28
Customer: New Hope
311 3RD AVE
MOSES LAKE, WA 98837
Account No Payment'Terms
oue, Date Invoice1otall
Balance Due
.505/2023 ----- 71.
- - ---- ----- - ------ --- LO -71;
- ----- -- - ---- -------------
Invoice.-RemArks'-
----- ------
ntract Number� �
MOON&Wiltract Amount 1 P*0. Number... Start Date ft Date.
P*
1313177-011 $988.27 Waoft"
10/18/2019 10/17/2025
coni 0,1w -----------
a
Summary*
Contract base rate charge for the 4/18/2023 to 5/17/2023 billing period
$150-53
Contract overage charge for the 1/1812023 to 4/17/2023 overage period
$728.19
Service Base Copier.
.
$ i0q.55
**See overage details below
$988.27
Detail:
Equipmeat inclUded under this. contract
Sharp/SAM X3071
Number Serial Number Base Adj.
Location
KC28150 95113987 $0.00
'New Hope 3113RD AVE
MOSES LAKE, WA 98837
Meter ly Meter, Group., Begin Meter End Meter ------- ---- ----
Total Covered
Billable Rate Overage
Color COLOR 67,700 79,900
12,200 11500
10,700 0.053200 $569.24
-103fDO0
. . ..... - .. . ...............
..... . ... 18,700 0.0085otL..
Estimated meter reading
$728.19
REMIT PAYMENT TO;
Kelley Connect
22710 72nd Ave S
Kent WA 98032
206-284-9100
Payment by credit card may be subject to a 3% surcharge.
To pay online., visit our website: www.Kelleyconnectcom
Invoice SubTotal $988.27
Tax: $83.01
Invoice Total $1,071.28
Balance Due: $1,071.2 8
Page I of I
4125=23 202A
Kelley Cannot fir, ter Mase. f 63.17
....,
wvcv
VOU
out
825
OtT 8039
0021 $074
_
n8 �3
i2g, t�
�.........1
t MA
tent
County of Grant
35 CST NW
P.O. Box 37
Ephrata WA 98823
Vendor: Century Link...,
P.O. Box 91155
SeattLe WA 98111-9255
------------- Document Number Purchase Order Number
05132023-1701
Office Phone
Page 1 /1
Invoice 0389367
Date 5/23/2023
Vendor ID Shipping Method
Payment Terms ID
N -R-ET-36-------
.... ......
Amount
$88,436
Subtotal
$88.36
Misc
$0.00
Tax
$0.00
Freight
$01,00
Trade Discount*
$0.00
Payment
$0.00
Total Due
$88.36
i
lip Im
Page I of 4
TM
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CenturLink
NEW HOPE DOM VILNC
Bill Date:
May 13, 2Q23
Aowunt Na; 609-766-17013038
Vii certurylinkoom
Previous Balance
Charges
Payn*nt Maly 08
B*bnoa Forward
Now Charg"
CenturyUnk
Total Novi Charges
i f. dt f I F 4 '+Y 4 1�1♦ i 1 4s i kf IfW
tfN
e
Account Summary
Thankyou foryourpgyment.
For qutmtions, call: Pago
1800 603-6000 3
88-36
88 9
$ 36
* ,
-00
88.36
$88-36
Business needs ohiange regularly. As a valued bu-sine&s austorner, we want to work
with you to provide a oompI and cost eff8(*V0 sOlUtion for your business.
Call,88) 644-4495 today for a free Acwunt 00naultation with 4 dedfoated busineoonsultant.
....... ...- For 'billing or teohnioal qUegtoftr, Please call (877) 453-9407,
Contu W. 0 ------
0 &i 91155, Seattle, WA' "925
Prime fdd, tear her and reran this per#cn Wth your paymen t
Bill Date: May 13 2023
S3 PA
�e Amount No: 509-765-17016038
Cen uryL nkYm Bill Due Date: Jun 2, 2023
822MSOO C3 RP 00 20230602 AN 0000808 0003 New Charges: $88-36
11111 111111111111111 111111111111 fit 11111 TOTAL AMOUNT DUE,- $88-36
NEW HOPE DOM VILNC Oil
311 W 3FID AVE Amount Enclomd
MOSES LAKE WA 98837-1905
CENTURYLINK
P 0 BOX 91166
SEATTLE, WA 98111- SS
71509765170130331OU00051300000000000000088369
0
Page 2
T M.
CenturyLink
w.. NEW HOPE DOM VILNC
Bill Date: May. ' 3d !023
For questions, call 1800 603.6000 Account No: 509 7 5 17013038
..............
A0........ .
aa
A fiats payment charge of 5.0% or $11.00, whichever Is greater, may apply If amount due does not reach us by
Jun 13, 9023, ex pt Internet eharges. Separate late payment ohiarges apply to Internet services.
New Charges
Local and
Other SmIoes
Monthly Charges
77.07
Taxes, Fms and Surcharges
State Sales at 6.6%
5.96
Local Sales at 1.7%
1.35
Special D161triot Sales at .2%
A7
C4 Occupation at 60%
3.67
State 911 -at $,26 per
aocess line
.25
Local 911 at $.70 per
access line
.70
Subtotalll
Total New Charges
$88.36
82202500 C3 RP 00 20230600 NNNNNNNY 0000688 0003
- W�
-
TM
page 3
saw
1&-*kitu ryL I* n kTu
NEW HOPE DOM VILNC
Bill Date: May13,2023
For questions, call 1800 603-6000 Aowunt No,� 609-766-1701 303B
Local and Other Services
Amour#
State Siles at 6.6%
Monthly Charges
1.0041 Sales at 1.70%
6.25
Charges from May 13 to jun 13
1.36
City Oooupation at 6%
Quardity Deswiption Codo
ftem Rate
Amount
Non-Telecorh Svc surcharge NT1
Choice Busine"
2.99
2.99
(includes; line Unistar
This arge, funds the cost Of providing amer.genoy
. 7 0
uP tO 6 60100ted PfeatureG
Toll Restn*coon Service s) OBA
69-60
Induberividual & Key es RTY
S Uno CLinharge SLM
3,00bson"
$11-29
Access Recovery Charge.
SZR23
6.47
2.60
647
2.60
Federal Univemal Sery Fund at 2910%
I
This charge recovers the amount Oent uryLink co ntriboes to the
2 .61
Fedaral Universal Service Fund. rhis fund helps keep local
phone rates affordable for all Amedoans'
Total Monthly Charges
$77.07
Taxes, Fees & Surcharges Summary
The detail listed below has been included In the Now Chargee on ftb bill.
This: summary Is provided as Informafion oily.
Federal Excise - Exempt
Amour#
State Siles at 6.6%
1.0041 Sales at 1.70%
6.25
Spect4l Dittrict,$aJo at' -.2%-
1.36
City Oooupation at 6%
State per access line
3.57
This aurcharge, funds the cost of providing Omer em
service's communications systems In your community.
Looal'91 I at110 per tt"*ss line
This arge, funds the cost Of providing amer.genoy
. 7 0
servtoes Communications systems in your community.
Total Taxes, Fees and Surcharges Summary
$11-29
Total CenturyLlnk Local and Other Services
$88,36
CenturyLink New Charges $88.36
For' ur Information
Customers using Teletype (TTY) devices can direct their inquiries to CenturyUnkat 1800 223 3131 , a TTY equipped nurnber.
continued on back ;?
CenturyLink-m
For questions, call 1800 603.6000
For Your Information
Go Greent Use Control Center at control centercentutylink,com
to view your billing and service Information on-line and
enroll In Paperless Billing or One Page Direct.
Ss� "W"t"A
Page 4
NEW HOPE DOM VILLAC
Bill Date: May 13,2023
Account No: 609-766-1701 303B
Save time and learn more about the taxes and fees listed on your bill .bar visiting our website at
www.eenturyfl*nk"*OnAaxotarKifees today.
TTX Symbol Explanation, -
Explanation of tax symbol$ used throughout the bill
S state sales
L Local Sales
Charges for your monthly service are billed one month in advance.
Century' nk should receive your payment for the total amount due on or
before the due date on your bill. If you are unable topay by the due
date please contact. Customer SepAce to avoid possible collection action.
In sone states you may be assessed a charge for unpaid balances. Your
basic telephone service Wil not be disconnected for non-payment of
charges for: (i) CentutyUnk Unregulated Services (or other itemized
ser foes) Identified by an *, (2) services of other CenturyUnk companies,
or (3) services of other companies Included in your bill. CenturyLink
pa�►ges of features and the amounts in the Account Summary may
include both basic and charges that are not basic,
Catalog/Rate Scheduleinformation for your servioes is available without
charge at your service providere web site or by calling their toll-free
number. Catalog/Rate Schedule Informati .' n for CentutyUnk services is
available without charge at www'.oenturylinokoom or by calling the
toll-free number listed on the summary Page of your bill,,
IMPORTANT NOTICE ABOUT CenturyUnk Une Volume Plan: Effective July 1 j 2023, the CenturyUnk Un e Volume Plan
will no longer be offered to now customers under *1 A. or 6 year terms. Exisfin I
�--Or) g customers with a 3 4 or 6 year
term comrnitment are grandfathered until the expirition date of their current term plan, after whioh they may.
enroll' 'n a two-year term agreement at the tadff6d rates then In effect. Otherwise, mtes previously discounted
under the grandfathered term plan will revett'to month-to-month rates in effect for the aeMces '
, provided.
Effective June J 2023 Joint User Service, Market Expansion Una&, Remote all Forwarding, Single Una ISDN
Service, ISDN -Basic Rate Service, and additional and foreign listings Will be grandfathered for small business
customers and vWII no longerbe available to new small business custors. A grandfathered service is one that is
no longer said, and availability is limited to lines currently in servimece at 9)(isting lona ons. Changes,
additions, or transfers of service will not be permitted on accounts associated with these grandfathered services.
You may remove it grandfathered servioe or listing from your account at Any time. Please note,,however that
grandfathered services and listings removed from your account may not be subsequently rein
On June 12023 International calling plans may increase by up to $3.00 per month, Per minute International call
rates will change and my vary by calling plan. A list of countries and the revised per minute rates are available
at www. oenturytink.00nAadff�ending—changes.pdf through June 1 2023 after which interna nal rates will be
located in Centuryl-inkspublished rate sohectules at WWW-cQnt*uryI1nk.'*oi;;i0ffs. Choice International basic and
discounted International rates will be grandfathered. A grandfathered service is one no longer sold, and
availability is limited to lines currently in service at existing location&. Changes add . tionsor transfers of
service are not permitted on accounts associated Frith gmndfathered services. ,
)Youl may remove a grandfathered
service from your account at any time. Please note however, that grandfathered se fices and 11'
your account my not be subsequently reinstated. r%n stings removed from
Thirarty Billing Bek
Cramming occurs. when unauthorized charges appear on your telephone bill. To help prevent unwanted third party
charges on your bill, contact CenturyLink at 800-603-6000 and request at no oharge, a bill block thatwill
prevent some third party oharges such as charitable contributions, dial-up Internet by non-CenturyUnk companies
or other tion telecom charges from appearing on your bill.
5/1312023 aou om
Century Unk - 1701 - Office Pham 36.36
SM.36
nil
$3
SM.36
County of Grant
35 C ST NW
P.O. Box 37
Ephrata WA 98823
Vendor: Century Link....
P.O. Box 91155
Seattle WA 98111-9255
Document Number
�32023-434-6
Description:
Office Phone
Purchase Order Number
Page 1 / 1
Invoice 0389365
Date 5/2312023
Vendor[D Shipping Method Payment Terms ID
Amount
$91.67
Subtotal $91.67
Misc $0.00
Tax $0.00
Freight $0.00
Trade Discount $0.00
Payment $0.00
Total Due $91.67
0
FAI CenturyLink~
" �A.,_%w
;eA �v
Visit conturylinkoom
000
$-00
$%,,67
Account Summary
Page I of 7
NEW HOPE DOMESTIC VIOLENCE
Bill Date: May 1312-023
Acmunt No: 509-765-4346 765E
Previous Balarme
Charges
Payment May 08 71hankyou foryourpayment. 90.09
Forward 90.09
Bare�
Now Charg" For questions, call- Page $.00
CentutyUnk 1800 777-9594 3 7 9..51
Long Distance Service 1 $00 777-9594 5 12.16
Total Now Ctmrges $91.67
.....................
f i1
A .......
TOTAL
A late payment charge of 5.0% or $13,00, whichever is greater, may apfly if auntdue does not reach us by
r
Jun 13,2023. Separate late payrnent charges apply to nternet servioes.
CentuiyLlnk, P 0 Box 91 1551 Seattle, WA 98111.9255
Please fdd* tear here andretum this poiton mth yourpayment.
L4 A PAT
CenturyLinkm
6220-2600 C3 RP 00 202WSOO NNNN 0000709 0003
11,1 1,11 if #11111,1 11 1111 1111
NEW HOPE DOMESTIC VIOLENCE
311 W 3RD AVE
MOSES LAKE WA 98837-1905
W1 liate:
Aunt .No. -
ill Due Date:
May 13 2023
509-765-4346 5B
Jun 212023
New Charges: $91-67
TOTAL AMOUW DUE: $91.67
Amour* no
�.
CENTURYLINK
P 0 Box 91158
SEATTLE, WA 98111.9266
�IIII�Ii���ll���ltll��llia��dl��n��lla�1l���ll��ll�����i��li���
715097654346765810000051300000000000000091678
Page
AhSl W
CenturyUnkTM
NEW HOPS DOMESTIC VIOLENCE.
Bill Date. may 1, 2023
For questons, Ca[! 1 800 777-9594 K � Amount o: 509-765-4346 765B
Now Charges
Lel and
Lo DWanoe
Other Servioes
Monthly Charges.
t CarderComputed Charges
Taxes, F and Surcharges
.0
City Occupation at3.63
State 911 At x,25 per
Amoss In
Local 911 at 10 per
.26
access lime
x ,,
Carder Cornuted Taxes
3,07
Beit
$79. 61
$12.16
Total New Charges
1
822()2600 03 RP 00 20230609 NNNNNNNY 0000709 000;3
Page 3
Ge ntu ryUn k tm NEW HOPE DOMESTIC VIOLENCE
&111 Date - May 13, 2023
qu
For estions, oall 1800 777-9594 Aunt 'No 509-765.4346 766E
LK#T* t
Monthly Charoes
Charges from May 13 to Jun 13
owntity Dewription Code
Remote Access Forwarding AFD
Non -Published Service NPU
Business Line I FS
Subscriber Line Charge 9Z8
Access Recovery Charge 9ZR42
Federal Universal Ser Fund at 35.10631Y,
This charge recovers the amount Centry tink contributes to the
Federal GnIversal Service Fund. This fund helps keep local
phone rates affordable for all Americans.
Federal Universal Sery Fund at Mo
This Charge recovers the amount CenturyLink contributes to the
Federal Universal Servica Fund. rhis ftine helps keep local
phone ratos affordable for all Americans.
Total Monthly Charges
ftemme Amount
9.-00
9.00
8.0 0
8. 0 0
43.50
43.60
6.91
6.91
61-00
.96
Taxes, Fees & Surcharges Summary
Tho detail listed below has b"n * oluded ' in the New Chargee on this bill.,
in
This summaiy ig provided as informagon only.
2.07
$74.93
Federal Excise - ExqnVt
Amount
State Sales - Exe.rMt
Local Sales * Exempt
City Occupation at W.
state 911 at $16 per access line
3,63
This surcharge, funds the 00,qt of providing emergetvy
.96
s to ervi00-9 cOmmun' atiOnS systems in your commUnity.
L00al 911 at $10 per amass line
70his SUrcharge, funds the cost of providing emergency
services communications Systems In your community,
Total Taxes, Fees and Surcharges Summary
Total CenturyLlnk Local and Other Services
$79.61
CenturyLink New Charges
continued on back
0
,��� CenturyLinkm
For q uestions, call 1800 777-9594
For Your Information
Page 4
^r"
NEW HOPE DOMESTIC VIOLE %.or
Bill Date: may 13,9023
Account No: 609.765-4346 7668
Customers using Teletype (TTY) devices can direct their inquiries to Centuryl-Ink at 1X00 223.3131, a TTY equipped number.,
Go Greenl Use Control Center at controloenter.oantutylinkzorn
to view your billing and seMce Information on-line and
enroll in Paperless Billing or One, page Direct.
Save time and learn more about the taxes and fees listed on your bill by visidng our website at
www-centutylink-comAaxesandfaes today.
Charges for your monthly service are billed one month in advance,
CenturyUnk should receive your
payment for the total amount due on or
before the due date on your bill. If you are unable to pay by the due
date, please contact Customer Setv'lee to avoid possible Collection action,,
In some states you may be assessed a charge for unpaid balances. Your
basic telephone servioo will not be disconnected for non-payment of
charges for: (1) CenturyUnk Unregulated Services or other Itemized
services) identified by an *. (2) Services of other encu Ink companies,
or (3) services of other con1vanies Included in your bill. Centuryl-ink
packages of features and the amounts in the Account Summary may
include both basic and charges that are not basic.
Catalog/Rate Schedule Information for your services Is available without
c: ha rg e at YO U r se tvice p rovideres web site or by calling their toll-free
number,, Catalog/Rats Schedule Information for CenturyUnk services is
available without oharge at www.eenturylink.00m or by calling the
toll-free number listed on the summary page of your bill.
P
IMPORTANT NOTICE ABOUT CenturyUnk bine Volunv Plan, Effective July I j 2023, the CenturyUnk line Volunw Plan
will no longer be offered to new customers under 3A or 5 yea"r terms. Existing customers with a.3,4 or 5 year
term commitment are grandfathered until the expiration date of their ourrent term plan, after which they may
enroll in a two-year term agreements the tariffed rates t I
hen In effect. Otherwise, rates previously discounted
under the grandfathered term plan will revert to month-to-month rates In effect.for the services provided,
Effective June 12023 Joint User Servilee, Market Expansion Unes, Remote Call Forwarding, Single line ISDN
Service, ISDN-Basto Rate Service, and additional and foreign listings will be grandfathered for small business
customers and will no Ion er be available to now small business customers. A grandfathered service is one that Is
no longer sold, and availat'llity is limited to lines ourtently in service at existing loeatio'ns. ChAnge-st,
additions, or transfers of service will not be pernitted on mounts associated with these grandfathered services.
You may remove a grandfathered service or listing from your account at ansub Please note however, that
grandfathered services and listings romoved from your aount may 'not beequently reinstated.
On June 19023 International calling plans may Increase by up to $3.00 per month. Per minute International call
rates will change and may vary by calling plan. A list of countries and the revised per minute rates are available
at www.c*nturylink.conVtafiffs/pending—changes,,pdf through June 1 2023, after which International rates will be
located In CenturyUnWe published rate schedules at www-centurylinKoorrOAriffs. Choice International basic and
discounted International rates will be grandtathered. A grandfather service is one no longer sold, and
availability Is If nited to lines ourronfly in service at existing locations. Changes, additions, or transfers of
servioe are not permitted on accounts associated with grandfathered services. YOU May remove a grandfathered
service from your amount at any time. Please note, however, that grandfathered setvioes and listings removed from
your account may not be subsequently reinstated.
Third -Party Billing Block
*
Oran ng occurs when unauthorized charges appear on your telephone bi I I . To help prevent unwanted third
charges on your bill, contact CenturyUnk at 800-603-6006 and request, at no charge, a bill block that will patty
prevent some third party charges such as charitable contributlons, dial-up Internet by non-CenturyUnk companies
or other non-teleoommunications charges from appearing on your bill.
62202600 C3 RP 09 20230600 NNNNNNNY 0000700 0003
A**&
(;enjuryLi#nkTm
NEW HOPE DOMESTIC VIOLENCE
Bill Date: May 133 2023.
n No -
609 766-4346 7651
Long Distance Service Customer Service
Long Distance Service Account Summary
Description pbas
Charges For May 5
Total Long DistService Account Summary
CenturyLink LwV Distance Summary of Charges for- May
Your LD AcccKmt Balance - CenturyLink COmmunioationso LLC
Current Service charges
Government Fees atwd Taxes
State and Local Taxes
WA Local Util*tY Tax
Subtotal
Other Fees 4 Monthly Charges
Federal Uni
IvOrs0l Sarvics Fund
Cost Recovery Foe
Property Surcharge
Administrative Expense Fee
Subtotal
Current Total Charges
On June 1, 2023$ International calling Plans may Increase by up to
$3..00 Per month Per minute 'International call rates will change and
May vary by calling Plan, A list of countries and the revised per
minute rates are available at
W'wwocenturYl:*tnk.com/tariffs`/`Pand.'Ino-Changes.pdf through June 11 2023,
after which international r .1
rates will be located In CenturyLink<s
Published rate schedules at www -centurylirk -com/ioriffs.
Choice International basic and discounted International rates will be
grandfathered. A grandfathered service is one no longer sold, and
availability is limited to dines currently in service at existing
locations. Changes p addlitlons s or transfers of service are not
Permitted on accounts associated with grandfathered services. you may
remove a grandfathered service from your account et any time. Peasenotai however, that grandfathered services and listings removed from
Your account may not be subsequently reinstated,
Service Sunmary of charges
Amount
12.16
$12.16
$9.09
Usage Nonrecur. Monthly Total
Calls M in * See CharVes Charges Charges Charges
Plan Feature Chrgs 0:00 0.00 0.00 3.99 3.99
continued on backq,>%*
TM
►,��� CenturyLink~
Ssrvice Summary of Charges
Page 6
NEW HOPE DOMESTIC- It
Bill Date 4. May� 3,
640 2 3
Account N 097 ! o: 5 3467668
Service Detail - Plan/Feature Charges
Description Qty- Period Nonrecurring Monthly Total
Charves Charges Charges
Long Distance Line Chrg, I APR 04 -MAY 03 0.00 3. 99 T ft4ft
7 7
:�tal Plan/Feature Charges $0.00 $3,99
$3.99
SsrviOe Detail - Long Distance Usage
509-765-4346
NO.
1
Usage Nonrecur.
Monthly
Total
Calls Min -.Sec
Long Distance 22 72:54
Charges
5.10
Charges
0100
Charges
Charges
20
3.
Apr
Apr
10
10
0100
5 ?# 10
!Total 2 72:54
$5.10
$0,00
$3.99
$9.09
Summary of Usage Reports
4,
Apr
10
1156
v
Domestic Sumory Report
509
8$S-6548
WENATCHEE
WENATCHEE
WA
WA
0:100 CenturyLink Business Basics III
.36
S.
6.
Apr
Apr
11
11
Description Period
1+ IIRALATA DAY
Calls
Min.sec
885-6548
885-6548
Charges
1+ INTRA ATA NITE
11
11
29,12
43:42
7.
2.04
subtotal
22
72:54
509
3.06
WENATCHEE
WENATCHEE
WA
WA
10:24
01-030
.7304
S.
9.
Total
U�
22
12:54
A
P
509
$09
Service Detail - Plan/Feature Charges
Description Qty- Period Nonrecurring Monthly Total
Charves Charges Charges
Long Distance Line Chrg, I APR 04 -MAY 03 0.00 3. 99 T ft4ft
7 7
:�tal Plan/Feature Charges $0.00 $3,99
$3.99
SsrviOe Detail - Long Distance Usage
509-765-4346
NO.
1
Date
Apr 10
Time
7:57
A
Called Number
509 885-6548
Lmmtion
WENATCHEE
Ml -.Sec
Charges
20
3.
Apr
Apr
10
10
8:47
11-05
A
P
509
509
885-6548
885-6548
WENATCHEE
WA
WA
0 "18
0*18
.02
.02
4,
Apr
10
1156
v
P
509
8$S-6548
WENATCHEE
WENATCHEE
WA
WA
5**12
4:06
.36
S.
6.
Apr
Apr
11
11
1:36
2:29
P
P
509
509
885-6548
885-6548
WENATCHEE
WA
0-.18
.29
.02
7.
Apr
11
5*44
P
509
885-6548
WENATCHEE
WENATCHEE
WA
WA
10:24
01-030
.7304
S.
9.
Apr
Apr
13
13
8:04
6,,49
A
P
509
$09
885-6548
885-6548
WENATCHEE
WENATCHEE
WA
0#.18
.02
10.
Apr
24
8:01
A
509
885-6548
WENATCHEE
WA
WA
0 54
06
0:18
.02
62202500 C3 RP 09 20230609 NNNNNNNY 9 0003
- SIN`
Page I
CenituryUnkTm NEW HOPE DOMESTIC VIOLENCE
Bill Date: May 13,2023
Aow u nt No; 609-766-4346 765B
Service Detail - Long Distance Usage
509-765-4346
NO
1.
Date
Time
Called Ntx*er
Location
Min. -See
Charges
Apr
24
12-37
P
509
88S-6548
WENATCHEE
WA
3-00
2.
Apr
30
7:48
A
509
885-6548
WENATCHEE
WA
0018
.21
3.
Apr
30
9:11
A
509
$85-6548
WENATCHEE
WA
5:24
.02
4.
Apr
30
1:41
P
509
885-6548
WENATCHEE
WA
5:36
.38
So
may
02
1:13
P
509
670-2437
WENATCHEE
WA
04.1802
.39
6.
may
02
11#21
P
509
670-2437
'E A`
WA
17:18
1:21
7.
May
0.3
8-01
A
509
$99-2886
ELLENSBURG
WA
of -136
a.
may
03
1:02
P
509
$99-2886
ELLE UR
WA
3 #*54
.04
9.
may
63
1**06
P
509
899-2886
ELLENSBURG
WA
0 -18
.27
10"
may
03
3:27
P
509
899-2886
ELLENSBURG
WA
94 -*30
102
11.
may
03
5*01
P
509
899-2886
ELLENSBURG
WA
0-36
.67
12,
may
0 3
5.4 02
P
609
:899-2886
ELLENSBURG
WA
3,*",30
.04
.25
Total calls for 509-765-4346 22 72-.54 $5.10
Lon,9 Distance Line Chrv. Report
Phone Nw*er L Ine Type Amount
509-765-4346 Long Distanoe Lima Charge 3.99
Total Long Distance Line ChM* $3.99
This Portion of Your Bill R-efieds Calls Served. 8
y OenturyUnk Communldatlons# LLC.
4U04d VOWO - gKir �; Wi AIMUDO
$rot
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color-
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Page 1 /1
Invoice 0387453
Date 4/2511023
County of Grant
35 C ST NW
.P. 0. Box 37
Ephrata WA 98823
Vendor: LINDSAY WATER POOL & SPA
P 0 BOX 189
EPHRATA WA 98823 -
Document Number-- - ------
_!urchase Order Number VendorD Shipping Method Payment Terms ID
136457
-7 LNDSY
bescr—ipt—fon., NET 30
Office Suppty Amount
$86.72
Subtotal
$86.72
Misc
$0.00
Tax
$0,00
Freight
$0.00
Trade Discount
$0.00
Payment
$0.00
Total Due
$86-72
IF PAYING BY CREDIT CARD* PLEASE CHECK CORRECT CARD AND FILL OUT BELOW
ft . Ok
VI0
011~.l
PLEASE CHECK BOX TO ENRS4 c
0 m IN AUTOMATIC BILL PAYMENTOLL
CULLIGAN/LINDSAY
o
1229 Basin ST SW, PO BOX 189
CARD NUMBER
V. CODE
EPHFEAT A., WA 98823
SIGNATURE
ERCP. DATE
(509) 754-4200
---
DATE - --
PAY THIS AMOUNT ACCOUNT NUMBER
04/18/2023
X 6.7 246488
INVOICE NUMBER: 130457
AM-OUN T
PAJD
County of Grant
35 IC ST NW
P.O. Box 37
Ephrata WA 98823
Vendor.- DeVries Business Records Management,, Inc.
601 E Pacific
Spokane WA 99202
Document Number Purchase Order Number
0165100--:-----D
Description:
Document Shredding
Ven dor lD
Page 1 /1
Invoice 0388005
Date 5/2/2023
Shipping Method
Subtotal
Mise
Tax
Freight
Trade Discount
Payment
Total Due
NET
Payment Terms ID
Amount
S13,80
$13.80
$0.00
$0.00
$0.00
$0.00
$0.00
$13.80
DEVIDT
Invoice
L\JLES
�I�SS SERVICES
DeVrIes Business Serv*
Ices
601 E. PACIFIC
601 E. PACIFIC
SPOKANE, WAS 99202
SPOKANE, WA 99202
(509) 838-1044
(509) 838-1044
866A33-4691
(866) 433-4691
w-mv.devriesinc.com
khopper@devriesinc.com
GRANT CSC UNTY NEW HOPE
Date:
04/30/2023
Attn: ALYCE BARRIENTOZ
311 W. 3RD
Invoice #:
0165100
MOSES LAKE, WA 98837
Customer
GONEWHOPEI
Terms,-
Net 10
Total Amount Due: 13.80
Total Enclosed
NOTE: DeVries also offers professional and trustworthy service in Document D'estruction, Business Records Storage, Courier
Services, and Commercial Office Moves!
SERC' EDESCRIPTION RATE OUAIS MY TAX FEE
mw 0 0,
No Invoice Category
On -Site Record Destruction - Sm $6.9000 1.00 N $6.9000
On -Site Record Destruction - Console $6.9000 1.00 N $6.900 0
Remit To: SUB -TOTAL $13.80
601 E. Pack Spokane, WA 99202
TAX $0.00
INVOICE TOTAL $13.80
Page: 1 Invoice
Rev.20230130.0625622.5.1,1.14
BKM#
Page I /I
Invoice 0387857
Date 5/1 /2023
County of Grant
35 CST NW
P.O. Box 37
Ephrata WA 98823
Vendor: GRANT CO HUMAN RES
--------------
Dotum.ent Number Purchase Order Number 'vendor IDS '
Shipping Method Payment Terms ID
04012023 -,HR �GCHRS 30
Description: - --------
Aprit FIR Service Amount
$17354.67
Subtotal
$1 }354.67
MSC
$0.00
Tax
$0.00
Freight
$0.00
Trade Discount
$0.00
Payment
$0.00
Total Due
$1,354..67
-Y
M
Invoice for Human Resources Services
In advance of summer grant. deadlines, Human Resources is
asked to use headcount reports to set a cost-sharing amount for
each non -general fund budgets utilizing, HR services.
Department New Hope Invoice Date 04/01/23
Contact Alyce Barrientoz Invoce Amount. .$111354.67
This invoice will be used for departments tea generate vouchers
for revenue payment to Human Resources.. Processing questions
should be directed to the Auditor's Office - Accounting
Department,
1K;vk
Kirk Eslinger
FIR Director
Apnt HR Service
lHuman Resources
Es �l
1,35467
Mal
$320
805T
sm
0021
0072
Igif
fa
G� 4C
4C
E '
L13
58.70
32,3
30f>,3f
06
9M
---- 10.54 1
-1 139.23
76.26
is
31,61
li. i760
LW
1,35467
County of Grant
35 C ST NW
P.O. Box 37
Ephrata WA 98823
Vendor.- KornbUt, Eric J
2448 SW Nebraska St
Portiand OR 97239
Document Number Purchase Order Number Vendor Ili
7-- 1.-- --
1/23-12/3'/2-3--'---'-- KORNE
Description.* .... . ...
Lease Agreement
Page 1 /1
Invoice 0381085
Date 5/18/2023
Shipping Method Payment Terms ID
NET 30
Amount
$11,800.00
Subtotal
$1,800,00
Misc
$0.00
Tax
$0.00
Freight
$0.00
Trade Discount
$0.00
Payment
$0.00
Total Due
$1,800.00
`jw1�- �,ct Z3
LEASE AGREEMENT
(RESIDENTIAL PREMISES)
The undersigned, GRANT COUNTY, duly organized and operating under and by virtue
of the Constitution and the laws of the State of Washington, by and through New Hope,
C T`enanf '), has on this day of February 2022, executed this Lease Agreement and
leased from Eric (`'Landlord")= the premises situated at
loon
(".Premises"'), beginning March 1st, 2022 and
ending February 28th, 20240
1, RENT
The monthly lease payment Cgent" for the Premises, which Tenant agrees to
THOUSAND EIGHT HUNDRED DOLLARS pay, is ONE
of each month. ($1,800-00), payable on or before the fifth (51h)
If any rent is not paid on or before the due date thereof, a late charge of 10% of the gross rent
schedule, or $50.00, whichever is greaterl will be assessed on the tenth (I Oth) day of the month
for which the rent is due.
Rent shall be payable to the Landlord at the following address:
Eric Komblit
2448 SW Nebraska St
Portland, OR 97239
2. UTILITIES
In addlition. to the rent, Tenant shall pay all utilities applicable to and/or related to the Premisesas
they become due, such utilities defined as electricity, gas, water/sewer, garbage, cable and
telephone.,
3. SECURITY DEPOSIT
Tenant hasprevi 'ously tendered under a prior agreement the sum of SEVEN HUNDRED AND
FIFTY DOLLARS AND NO/ CENTS ($750.00), as a Security D e- osit for the performance of
1 4 p
Tenant's obligations hereunder, an.d. Landlord hereby acknowledges receipt of the same. Tenant
agrees that such sums shall be (or have been deposited by the Landlord, or Landlord's Agent, in
a depository as the Landlord oris successor(s) may *identify to the Tenant.
Tenant hereby agrees, acknowledges and understands that all or a portion of the Security
Deposit may be retained by the Landlord upon termination of the tenancy and/or that a
refund or any portion of the Security Deposit to the Tenant is conditioned as follows:
(1) Tenant shall have complied with all of the conditions of this Lease Agreement.
(2) Tenant shall clean and restore Premises to its condition at the commencement of
this tenancy as evidenced by the Residential Move-in/Move Out Condition".
Residential Lease Agreement - Page 1 of 7
County of Grant
35 C ST NW
P.O. Box 37
Ephrata WA 98823
Vendor: PADILLA, MA IO
10281 BASELINE E RD
MOSES LAKE WA 98837
Document Number Purchase Order Number VendorlD,
8 11/22-7131/.23
Description:
LEASE AGREEMENT
Page 1 / 1
Invoice 0381086
Date 5/18/2023
Shipping Method Payment Terms ID
-Amount
$3,713,97
Subtotal
$3)713,97
disc
$0.00
Tax
$0.00
Freight
$0.00
Trade Discount
$0.00
Payment
$0.00
Total Due
$3,713,97
I
Rent *s due,, in advance, without receipt of a billing or statement,
the fnt, day' of each
month and is to be paid directly to THE. LESSOR. A one and one-half percent (1 .5%) service
charge will be collected for payments received after the tenth of the month for the month
which they are due. If any check received by THE LESSOR is returned for anyreason, THE
LESSOR will make an additional charge of T° en Dollars ($25.00).
In. the event the term of this Lease shall hem or end other than on the first day of a
calendar month, the rental for any such partial, month, shall be pro -rated. Rental for months other
than partial months shall be paid on the first day of each calendar mond "in advance for the
ensuing month,
I OTHER TAXES: THE LESSEE shy .pad all taxes,'licenses and fees, Which by
law are imposed on THE LESSEE, by reason of THE LESSEES operati
County of Grant
35 C ST NW
P.O. Box 37
Ephrata WA 98823
Vendor: PADILLA, MARIO
10281 BASELINE E RD
MOSES LAKE WA 98837
Document Number
8/1122-7/31123
64 W$4 i —P0 o n
LEASE AGREEMENT
Purchase OrderNumr Vendor ltd
rE
�PADILI
Page 1 /1
Invoice 0381156
Date 5/18/2023
Shipping Method I Payment Terms ID
Amount
$3,692.00
Subtotal
$3)692.00
Misc
$0.00
Tax
$0.00
Freight
$0,00
Trade Discount
$0.00
Payment
$0.00
Total Due
$3)692.00
2
0
Rent is due, in advance, 'wishout receipt of a billing or statementhe first day of each
month and is to be paid directly to THE LESSOR. A. one and one-half percent(1.5%) service
charge will be collected for payments received after the tenth of the month for the month M*
which they are due. If any check received by THE LESSOR is returned for any reason, THE
LESSOR will make an. additional charge of Twenty -Five Dollars ($25.00).
In the event the term of this Lease shall begin or end other than on the first day of a
calendar month the rental for any such part"al month shall be pro -rated. Rental for months other
d
than partial months shall be P aicin the first day of each calendar month, in advance for the
6
ensuing month.
3. OTHER TAXES: THE LESSEE shall pay all taxes, licenses and, fees, which by
law are imposed on THE LESSEE, by reason of THE LESSEE'S operations or upon any of THE
LESSEE'S personal property situate in or about the leased re uses. If other taxes, licenses or
f.
fees, which by law are imposed on THE LESSEE or assessed upon the premises leased herein
during the term of this Lease by any governmental agency, THE LESSEE shall reasonably pay
SaMe.
4. USE: TBE LESSEE shall not use said premises for any other purpose other than
the use of general executive office space and the uses resulting thereby without the prior written
consent of the Lessor, in which said consent shall not be unreasonably withheld. THE LESSEE
agrees that no stock of goods will be carried or anything done in or about the premises which
will increase the present rate of insurance. The rental contained herein is predicated on, among
other things, THE LES SOR!S existing *insurance premiums, and in the event that THE LESSEE'S
Commercial Lease
Page 2
0
Year
One
Year
Two
Year
-Three
Year
our
Five
Year S'
Seven
Kids Hope
81WO22
-7131123
8IW3-
7131122
811124-
-7131125
811125-
8131126
8IW6-
7131127
8IW7-
7131128,
8IM8-
7131129
Rent
Landlord
3}992.00
$4,15
$4,490.46
$4..670-08
$4 7856.88
5,051.x.5
Donated
Portion
$300.00
$300.00
$300.00
$300.00$300-00
$300.00
$300 .00
Net
Amount
Due from
New Hope _1$3,69,2.00
$3,851.68
$4,017.751
_$41190.46 1
$4.1370.08 .
$4.556.88
.1751.15 j
0
Rent is due, in advance, 'wishout receipt of a billing or statementhe first day of each
month and is to be paid directly to THE LESSOR. A. one and one-half percent(1.5%) service
charge will be collected for payments received after the tenth of the month for the month M*
which they are due. If any check received by THE LESSOR is returned for any reason, THE
LESSOR will make an. additional charge of Twenty -Five Dollars ($25.00).
In the event the term of this Lease shall begin or end other than on the first day of a
calendar month the rental for any such part"al month shall be pro -rated. Rental for months other
d
than partial months shall be P aicin the first day of each calendar month, in advance for the
6
ensuing month.
3. OTHER TAXES: THE LESSEE shall pay all taxes, licenses and, fees, which by
law are imposed on THE LESSEE, by reason of THE LESSEE'S operations or upon any of THE
LESSEE'S personal property situate in or about the leased re uses. If other taxes, licenses or
f.
fees, which by law are imposed on THE LESSEE or assessed upon the premises leased herein
during the term of this Lease by any governmental agency, THE LESSEE shall reasonably pay
SaMe.
4. USE: TBE LESSEE shall not use said premises for any other purpose other than
the use of general executive office space and the uses resulting thereby without the prior written
consent of the Lessor, in which said consent shall not be unreasonably withheld. THE LESSEE
agrees that no stock of goods will be carried or anything done in or about the premises which
will increase the present rate of insurance. The rental contained herein is predicated on, among
other things, THE LES SOR!S existing *insurance premiums, and in the event that THE LESSEE'S
Commercial Lease
Page 2
0
Mate.
ario Padib - KH Lo*zo 292.00.
to
wig*
IM74
W73
31
MAN
.52
Natio Padilla - Thoroprom: J 4k.-io- I I __ I - I - -1 -----Ann
$ It an -06 S -I
Total Kids Hope Lease $3,692-00
County of Grant
35 C ST NW
P.0, Box 37
Ephrata WA 98823
Vendor: WASHINGTON TRUST BANK..
PO BOX 2127
SPOKANE WA 99210-2127
V,
Document Number Purchase Order Number endorID
Page I/ I
Invoice 0388750
Date 5/10/2023
S _,. __-_
?Q7A.ipping Met I Payment Terms ID
nA ATI
15
w 1 U. NET 30
Description, .......
Amount
Visa Statement 04/2023
$3,235.41
Subtotal
$3,235.41
Misc
$0.00
Tax
$0.00
Freight
$0.00
Trade biscount
$0.00
Payment
$0.00
Total Due
$31235.41
1146 LWG 3 7 1 230502 0 PAGE 1 OF 2 1 0 4833 0030 CX48
Cardholder Name and Account Number
SUZI FODE
GRANT COUNTY
A
111 XXXX-XXXX-XXXX-2976
p Vfth1nqtonTrust Bank
"R men-*vr rzoic
ljwj
OIAC1146
IfISA Page I of 2
Remit Payment to:
WASHINGTON TRUST BANK
PO BOX 2127 SPOKANE, WA 99210-2127
WASHINGTON TRUST BANK
PO BOX 2127
SPOKANE, WA 99210-2127
Please include your account
number an your check.
New address, photle number or e-mail?
Check the box to the left and prInt changes on back.
WASHINGTON TRUST BANK
PO BOX 2127
SPOKANE, WA 99210-2127
,f
nifj. Mail Inqui vino s To: Quest'ons?
P-0, BOX 2127 SPOKANE, WA 99210-2127 Call Customer Service, 800-788-4578
Lost or Stolen Card: 800-788-4578.
We appreciate your buslinessl
#59
Transactions
L Account Information---------
Post Date
Account Summary
May
Statement Closing Date
Credit Limit
05/02/2023
Previous Balance
$0.00
Available Credit
$10,000,00
$8,870.00
Payments and Credits
$0.00
Cash Credit Limit
$0.00
Finance Charge(net)
+ Purchases
$0.00
Available Cash
$0.00
+ Cash Advances
$0.00
$0=
$50.47 -`
04119
+ Other Charges
$0.00
AIRBNB HMZF2H5SQM AIRBNB.COM CA
$740,72
Now Balance
$0.00
24137463E0IIMMNDW
USPS PO 5456420837 MOSES LAKE WA
Payment infonnation.
04/20
Payment Due Date: 05/27/2023
24445003EBLLA6BVN
Minimum Payment Due: $0.00
New Balance: $0.00
Remit Payment to:
WASHINGTON TRUST BANK
PO BOX 2127 SPOKANE, WA 99210-2127
WASHINGTON TRUST BANK
PO BOX 2127
SPOKANE, WA 99210-2127
Please include your account
number an your check.
New address, photle number or e-mail?
Check the box to the left and prInt changes on back.
WASHINGTON TRUST BANK
PO BOX 2127
SPOKANE, WA 99210-2127
,f
nifj. Mail Inqui vino s To: Quest'ons?
P-0, BOX 2127 SPOKANE, WA 99210-2127 Call Customer Service, 800-788-4578
Lost or Stolen Card: 800-788-4578.
We appreciate your buslinessl
Transactions
Post Date
Trans DateReference
May
Description
Amount
04116
04/14
244550138447Y5J5X
WAL-MART #2007 MOSES LAKE WA
$48.72,-�
04116
04/14
24692163830NHTEXO
SQ *ANIMAL CRACKERS BOARDMoses Lake WA
$85-00---
04/119
04/19
24430993D2D.ZGE3ME
VIVINT INC/Us 800-216-5232 UT
$50.47 -`
04119
04/19
24492153DMLFLVR.RM
AIRBNB HMZF2H5SQM AIRBNB.COM CA
$740,72
04/20
04119
24137463E0IIMMNDW
USPS PO 5456420837 MOSES LAKE WA
$27,70
04/20
04/19
24445003EBLLA6BVN
M SUPERCENTER #2007 MOSES LAKE WA
$29,891 --lo
04/21
04/20
24638573EOEXGLS9G
LOC CITIZEN S*332177595 401-2825259 CT
$26.61 --*
04/23
04/21
24492153GPSW46WYE
BLD*NATIONAL REAL ESTATE 833466-7364 WA
$1,371,72
04/28
04/26
24000973MMTSVVH5S3
CENTENNIAL HOTEL SPOKANE WA
$131,79
041/28
04/26
24000973MMTSWH5X.6
CENTENNIAL HOTEL SPOKANE WA
$131,79
04130
04/28
24492163NO01AYXRX
EDGE PHYSICAL THERAPY V\AMN,EDGEPHYSIWA
$585-00
05/02
05/02
OOOOOOOOOOOOCOMPC
TOTAL PURCHASES $3,235,41
TOTAL $3,235.41
TOTAL FEES FOR THIS PERIOD
TOTAL INTEREST FOR THIS PERIOD
Remit Payment to:
WASHINGTON TRUST BANK
PO BOX 2127 SPOKANE, WA 99210-2127
WASHINGTON TRUST BANK
PO BOX 2127
SPOKANE, WA 99210-2127
Please include your account
number an your check.
New address, photle number or e-mail?
Check the box to the left and prInt changes on back.
WASHINGTON TRUST BANK
PO BOX 2127
SPOKANE, WA 99210-2127
,f
nifj. Mail Inqui vino s To: Quest'ons?
P-0, BOX 2127 SPOKANE, WA 99210-2127 Call Customer Service, 800-788-4578
Lost or Stolen Card: 800-788-4578.
We appreciate your buslinessl
SUZI FADE
GRANT COUNTY
ATTN MICHELE JADERWND
PO BOX 37
EPHRATA WA 98823-0037
000000000000000041295700310929768
Payment Due Date
May
Account Number XXXX-XXXX-XXXX-2976
S M T W .-F S
11: __ T
12 3 6
17
New Balance
$0.00
819 10 11112 13 ,
- -
1 4 - -16 -17.18 1
15 5
21 1 222 23 14 2S
MinimumPayment Due
NONE
29 iqsi
Amount
-3
Enclosed$
SUZI FADE
GRANT COUNTY
ATTN MICHELE JADERWND
PO BOX 37
EPHRATA WA 98823-0037
000000000000000041295700310929768
1146 LANG 3 7 1 230502 0 PAGE 2 of 2 1 0 4633
0030 GX48 OIAC1146
Cardholder lame and Account Number
Page 2 of 2
SU I FODE
IIISA
GRANT COUNTY
XXXX-XXXX-XXXX-2976
- _ Finance Char a Calculation
Annual Percentage .Rate (APR) is the annual interest rate on your account=
Type of Balance APR Average Daily
Finance Charge
iRama* g
% Balance
0.
Balance
$0.00
Purchases17',99�'10 (V)0.0
Ga Advances 20.9% ) $0.00
$0.00
0.00
Guys in Billing Cycle: 0 (V) = Variable Rate
See reverse side of page one for explanation of Finance Charge calculation. Credit Purchases calculated using Method G. Gash
Advance Char es calculated usin Method A.
FOR REBATE PROGRAM QUESTIONS, GALL. 800-788-4578.
IMPORTANT INFORMATION
Terms and Conditions
Please refer to the disclosure Previously provided for the Terms and Conditions, governing the
use of this account -These Terms and Conditions maybe amended or supplemented by separate
notices to you including any notices you have previously received from us.
CreditTerms
The Interest Charge Calculation Method applicable to youraccount fur Cash Advances and Credit
Purchases of goods and services that you obtain through the use of your card is specified WillYn the
Interest Charge Calculatjon$.ection of thisstatement and explained below.
Method A -The Interest Charge an Cash Advances begins to accrue on the date you obtain the
Cash Advance Or the first day of the billing cycle in which it is posted to your account, whicheyeris
later. TheInterest Charges for 4bi(ling cycle are computed by applying the daily periodic rate to
the average daily balance multiplied by the number of days in the billing Cycle. Each daily balance
is determined by adding to the Previous Balance; (the outstanding balance of youraccount at the
beginning of the billing cycle) any new Credit Purchases posted t I o your account and any new Cash
Advances received, and subtracting any payments as received or credits as posted to your account,
but excluding any unpaid Interest.Chattles Or overlimit fees. Method G - The Interest Charge on
Credit Purchases begins to accrue on the date each Is posted to your account. To, avoid incurring
an additional Interest Charge on the balance on Credit Pu rchases reflected on this statement and
on any new Credit Purchases appearing on your next statement, You must pay the flew Balance
shown on the reverse side on or before the pa true '
Payment Date, The Interest Charges for a billing
cycle are computed by applying the daily periodic erag e daily balance multiplied by
the number of days in the billing cycle. Each daily balance is determined by adding to the Previous
Balance of Credit Purchases any new Credit Purchases posted to your account and subtracting an.
payments as received and credits as posted to your account, but excluding any un aidinterest y
Charges or overlimit fees, p
THE EFFECTWEANNUAL PERCENTAGE RATE WILL DIFFER FROM THE CORRESPONDING ANNUAL
PERCENTAGE RATES IF CASH ADVANCE FEES OR OVERLIMIT FEES HAVE BEEN INCLUDED,
Note: If a variable rate plan is applicable to this account, the periodic rate may vary,
Payment Crediting
Payments received by 5 p.m, at the location
. specifiad on the front of the Slatementafter the
phrase �Remit Payment To.,' will be credited asof the dale O(Weil)ttO the UCOuflt specified or,
the payrnent coupon,* Payments made in person by 5 p.m. during normal business hours, Monday
through Friday, at branch locations wi ere such payments are accepted, will be treated as received
On the same day. Payments that do not conform to the fe.qvirements set forth on or with the
periodictqatement(e,g_ missing payment stub, payment enve I tape 0
therthan as provided with
your statement, m u.10ple. checks or multiple coupons in the same envelope) maybe subject to
delay in Crediting, butsball be credited within 8 days of fe.ceipt.
Credit Bal
ance
If there is a credit, balance due to you, you may request in writing a full refund of this credit balance
at the address Indicated on the front of the statement after the phtase 'Mail Inquiries TO.M
Additional Charges
AddWoflalcharges, plus applicable taxes, may also be assessed if you pay us with a.check not
honored byyour -Financiall. Institution, a copy of ai , documentmake
U , delinquent payments,
make charges which exceed your credit limit, req uesta Cash Advance, or use your card for a
transaction at an autnated teller machine, if such charges are not prohibited by taw or requlaaon,
Notice' -Chocks returned NSF(Non-Sufficient Funds) or USF(Uncolleeted Funds) are subject to
efectronicACH representment. The annual fee shall be treated as a credit purchase for purposes, of
calculating Interest Charges, unless prohibited by law,
Available Credit
The available credit specified an the front of the statement displays the amount of Your Credit limit
available for purchases. Available credit accounts for pending transactions that processed, but may
not have Posted as of the statement date and therefore are nbt retlected on the statement.
Available Cash
The available cash specified on the front of the statement displays the amount ofyour cash credit
limit available for cash advances. Available cash accounts for pending transactions It -hat processedt
but may not have posted as of the statel"rit date and therefore are not reflected on the statement,
Closing Date
.All transactions received after the closing date will appear on your next statement.
In Case of Errors or Inquiries About Your Bill
If you thinkyour bill is wrong, or If you need more inf6rmatjon: about a transaction on your bill,
write us on as-213af3te Sheet of paper at the address indicated the frofltof this statementafte r
the, phrise'Wil lnuirfe5 To,' as soon as possible. We must heat from You no later than 60 t
days after we sell t you the first bill on which th e, error or problem appeared Youcarr telephone
us, but doing so will not preserve your
. 60113. Calls received in our cardholder service center
are periodically monitored to ensure quality service to out Customers, In Your letter, give us the
following information:
* Your name and account num'ber
• The dollar amount Of the suspected error
• Describe the error andoxplain, ffyou can, whyyou believe there is w! error, If you need
more Information, describe the item You are unsure about,
You do not have to pay any amount in clitei'tion, while weare -investigating, but you are still
obligated to pay the p'arts of Y6 ur'bill Haat are: not in quesiion, While we investigate your question,
we cannot report you as delinquent ortake, any action to coffact the amoUnt-
you question.
If You have a problem with the quality of goods or services that ori purchaserd with a credit card,
and you have tried in good faith to, correct the problem; with the merchant, you may not have. to
pay the remainin- amount due on the good or service$. YOU have
9 . I . . this protection only when the
purchase price was mote than $50.00 an s
d the purchase was made in your home state or within
100 miles of Your Mailing address. (if we Own of operate the merchant, or if we mailedyou the
advertisement for th. e property or services, all purchases are covered, regardless of amount or
location of purchw)
Electronic Check ConversionlECK
When you provide a checkas, payment, you authorize us to I use information from your check to
make a one-time electronic Bend ir3ris'ferflom your account. in certain circumstances, such as for
technical or processing reasons, we may processyour payment as a check transaction. When we
use information from your Check to make ah el6ctrdnic fund trmsfeej fupds.rhay be withdrawn f I rotyl
Your account as soon as the saran day we receive your payment, and you will not t receive your check
back from your finandal institution,
01A01 146 - 3.04/21121
Change of address? Please supply the newinformation lin the boxes provided,
Str"t Address
Cardholder's Signature
Stmt AAd rm (cont.)
CIV
State nP Code
E-mail Address - -- ----- - - ---------
Home Phone
Business Phone
WO aPPrwJate Wr pa&onage and con dbuafly swve to provide quo littwice.
OA114600
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EMERGENCY FINANCIAL ASSISTANCE REQUEST FORM
Type of client:
VDV OSA
DCVSC 0 YHDP
* Background check for housing
* Children's needs
* Debt assistance
* Driver's license
* Education training
* Bus fare to return home
* Cell phone to -seek work/housing
* Family well being
► Housing Authority
Salvation Army
Serve ML/Quincy
DSHS
0 CPS
0 Family contribution
0 Friend contribution
• Mortgage
• Service DVPO
• Utilities bills
• Security Assist
• Rental Assist
• Car payments
Food/Necessities
Staff: SFode
Date Submitted: 4.24-2023
Amount requested $ $1329.50 + car payment
# of Children: 3
Client's Home City: Moses Lake
Explain:
Late rent, late fee, car payment. Possibly 1/2 of
May rent as well.
Explain:
None. The abusive partner was the option, now
that is no longer the option,
Updated: 2/1.1/2020
National Real Estate
Management Group
Account No.82 `512
- GRO - WA
Received from:
Generated 05/04/2023 02:55:08
Payment Receipt
Memo
Prepared By: National Real
Estate Management Group
15001 Kercheval Avenue Suite
103
Grosse Pointe Park, MI 482-30
Date Amount
Received
4/21/2023 $1371-72
Payment Method
Credit card
Page 1 of 1
County of Grant
.35 C ST NW
P.O. Box 37
phrata WA 98823
'Vendor:
WASHINGTON TRUST BANK..
PO BOX 2127
SPOKANE WA 99210-2127
Document Number Purchase Order Number
8493- 04/2023
Description:
Visa Statement 04/2023
Page 1 /1
Invoice 0388769
Date 5/10/2023
Vendorl!)
4 Shipping Method
Subtotal
misc
Tax
Freight
Trade Discount
Payment
Total Due
Payment Terms ID
Amount
$6,000-60
$6,000-60
$0.00
$0.00
O. 00
$0,00
$0.00
*000.60
1146 LWG 3 7 1 230502 0 PAGE 1 OF
1 0 4833 0030 GX48 01Ac1 146
Cardholder Hanle and Account Number Page 1 of 2
NEW HOPE SHELTER ADVOCATE IfISA
GRANT COUNTY
A"'l'laj�. XXXX-XXXX - XXX -8493
W�hmtT
�,Bank rFb
A=unt Infoirrnation
#17 -Account Summary
_
Statement Closing Date
Credit LimitPrevious
05102I2023
$20,000,00
Balance.
0,00
Available Credit
$18,571.00
. Payments and Credits
$0, 00
Cash Credit Limit
$0.00
+/-Finance Charge(net)
+ Purchases
0.00
Available Cath
�.
+ Gash Advances
�[�.�
$0.00
04/14
04113
+ tither Cha es
$0.00 ,.
$150.00--___
04/16
04/16
New Balance
$0.00 =.
CENTRAL BONDED 800-284-7974 WA
$2t520.71
!�#Yllnent Information'
04/1.4
Payment Due Date: 05/2712023
CONSOLIDATED DISPOSALS MOSES LAKE 'SVA
Minimum Payment Due: $0.00 New Balance: $0.00
WASHINGTON TRUST SANK
PO BOX 2127
SPOKANE, WA 992102127
Please include your account
number on your check.
Mew address, phone number or e-mail's
Check the box to the left and pant chess on back .
WASHINGTON TRUST BAIT
ISG SOX 2127"
SPOKANE, WA 99210-2127
Payment Due Date
May
Account Number XXXX- C -X)0-8493 s n� T W T F s
SC
1 2 4 5
New Balance $0 00 �' a 9 10 11 12 13
14 jA B j 7
Minimum Payment Due NONE 22 23 24 2-5 2
23 gj.3Q 3
:mount
Enclosed $ 60
NEW HOPE SHELTER ADVOCATE
GRANT COUNTY
ATTN MICHELE JADERLUND
PQ BOX 37
EPHRATA VSA 98823-0037
00000000000000004129570031008.4937
-Tratnsactions
Post Date Trans Gate
Reference.
...
Description
.......
Amount
04/04
04/03
24801972'Y2M5 LBX3
MOSES LAKE ACE HARDWARE MOSES LAKE WA
$42,30
04/06
04/05
24240522Z5SA02EQT
WA SECRETARY OF STATE 360-704- 5245 WA '`
$33.50
04/14
04113
2 43 06372D LPV9l
GRANT PUD 509-754-0500 WA
$150.00--___
04/16
04/16
04/13
2498894380PV9ZE91
CENTRAL BONDED 800-284-7974 WA
$2t520.71
04/1.4
2427,07438S66K907X
CONSOLIDATED DISPOSALS MOSES LAKE 'SVA
$16.80
04/16
04/14
24492153907 APV59
Al"*WINDERMERE PROP' ET� 09�?65-6�a91 A
$5.00
04/18
04/17
24445003135SB3SGAQ
WALMART,COM 8009666546 800-966-6546 AR
$
04118
04%17
24455013B447`C53R2
"�t�`AL-MART #2007 MOSES LAKE WA
48.20 -vpw"
0418
04/17
246926382ii13EL
.
1ALMART.Cil48.2Q
800-9fi6546 AIS
,
$431.52
04/19
04/13
25003 5SB7PP4E
WALMAR` .COM 8009666546 BENTONVILLE AR1
$ t�3.9�t� , -00*"
04/30
04/27
24692163N31 D 23,
UNITED 0169849847951800-932-27 2 TX
$1:26.00
04/30
04/27
24692163N31GD4PPM
UNITED 0162482797130800-932-2732 TX
$304.20
05/`01123
BL.AIR/PA:TRIGIA
r
1 UA Q
SPOKANE DENVER
2 UA Q
!DENVER COLORADO SPRINGS
/ t3
0 #f27
4692163N 1 GD4PPX
UNITED 0162482797131800-93.2.2782 TX
$804.20,$'
05/01123
LAIC ON/ALEX
Remit Payment to:
WASHINGTON TRUST BANK,
.�.
Mail Inquiries To: Questions?
P.O. BOX 2127 SPOKANE, WA 99210-2127
PO BOX 2127SPOKANE, WA 99210-2127 Cali Customer Service: 800-788-4578
Lost or Steffen Card:
800-784578
WASHINGTON TRUST SANK
PO BOX 2127
SPOKANE, WA 992102127
Please include your account
number on your check.
Mew address, phone number or e-mail's
Check the box to the left and pant chess on back .
WASHINGTON TRUST BAIT
ISG SOX 2127"
SPOKANE, WA 99210-2127
Payment Due Date
May
Account Number XXXX- C -X)0-8493 s n� T W T F s
SC
1 2 4 5
New Balance $0 00 �' a 9 10 11 12 13
14 jA B j 7
Minimum Payment Due NONE 22 23 24 2-5 2
23 gj.3Q 3
:mount
Enclosed $ 60
NEW HOPE SHELTER ADVOCATE
GRANT COUNTY
ATTN MICHELE JADERLUND
PQ BOX 37
EPHRATA VSA 98823-0037
00000000000000004129570031008.4937
1146 LW G 3 7 1 230502 0
PAGE 2 OF 2 1 0 4833 0030 CX48 01AG1146
Cardholder Name and ,Account Number
NEW HOPE SHELTER ADVOCATE
Page z of
IfISA
GRANT COUNTY
XXL -XX -XXX -8493
Tran c"'On (continued)
Past Date Trans Gate Reference
Description Arnaunt.
UA Q
SPOKANE DEFINER
ESA C
DENVER COLORADO SPRINGS
05/02 05101 24492153SOTXC 8F8
AF*WI DERMERE PRQPERT. 509-765-5691 WA $1,34537
05/02 05102 0000OOOOOt}0OCOMPC TOTAL PURCHASES $6,000-60 .
TOTAL $61000.60
TOTAL. PEES FOR THIS PERIOD
-------------
TOTAL INTEREST FOR THIS PERIOD
Finance Chaw Calculation
Annual Percentage Rete (APR) is the annual interest rate on your account.
T of Balance AP's
Average
0p .Finance Chars Remalnle
Balance
Balance
Purchases � (V) $0.00
17.99 / $0.00 $0.00
Cash Advances 20.9 % $0.00
... $'VkVSf ... $0,00
Days in Billing Cycle.: O (v) -- Variable Data
See reverse side of page one for explanation of Finance Charge calculation. Credit Purchases calculated using Method, Cash
Advance Charges calculated usiri LAethvd A.
PCXR REBATE PROGRAM' QUESTIONS, CALL 800-786.4578.
IMPORTANT INFORMATION
Terms and Conditions
Please refer to the disclosure previously provided for the Terms and Conditions governing the
use of this account.These Terms and Conditions may be amended or supplemented by separate
notices to you including any noticesyou have previously received from us.
Credit Terms -
The Interest Charge Calculation Method 3PPlicable toyour account forCash Advances and Credit
Purchases of goods and services that you obtain through the use of your card is specified within the
Interest Charge Calculation section of this statementand explained below,
Method A— The Interest Charge on Cash Advances begins toaccrue on the date you obtain the
Cash Advance orthe first day of the billing cycle in which it is posted to your account whichever is
later. The Interest Charges for a billing cycleare computed byapplying the daily periodic rate to
the average daily balance multiplied by the . number of daysin the billing cycle. Each daily balance
Is determined by adding to the Previous Balance (the outstanding balance of youraccountat the
beginning of the billing cycle) any new Credit Purchases posted to your account and any new Cash
Advances received, and subtracting any payments as received or credits as posted to youraccount,
but excluding any unpaid Interest Charges or overlimit fees. Method 6 —The Interest Charge on
Credit Purchases begins to accrue on the date each is posted to your accountTo avoid incur -ring
an additional Interest Charge on the balance on Credit Purchases reflected on this statement and
on any new Credit Purchases appearing on your nextstatement, you must I pay the New Balance
shown on the reverseside on or before the Payment Due Date. the interest Charges for a billing
cycle are computed by applying the daily periodic rate to the average daily balance multiplied by
the numberof days in the billing cycle. tach daily balance is determined by addit . rig to the Previous
Balance of Cmdit Purchases any new Credit Purchases posted to your account and subtractingany
,payments as received and credits as posted to your. account, but excluding any unpaid interest
Charges or over] imit fee$.*
THE EFFECTIVEANNUAL PERCENTAGE RATE WILL DIFFER FROM THE CORRESPONDING ANNUAL
PERCENTAGE RATES IF CASH ADVANCE FEES OR OVERLI MIT FEES HAVE BEEN INCLUDED.
Note: If a variable rate planisappl'Ica ble to this acco^ the periodic rate marry.
Payment Crediting
ng
Payments received by 5 p.m, at the location specified on the front ofthes,tatement aftorthe
phrase *Remit Payment To,* will be credited as of the date of receipt to the account specified on
the payment coupon, Payments made in person by 5 p.m. during normal buslness hours, Monday
through Friday, at branch locations where such payments are accepted, will be treated.as received
on the same day. Payments thatclo nOttonform to the requ:irenientssetfa th
t bit orwith the
pe riodic stateme nt(e.g, missing paymentstub, payment envelope other than as provided with
your statement, multiple checks, or multiple coupons in the same envelope) maybe subject to
delay in crediting, butsha 11 be credited. within 5 days o(rece.1pt,
Credit Balance
If there is a credit balance due to you, you may request in writing a full refund of this credit balance
at the address indicated on the front6f the statiinerit afterthe phrase *mail lnquidesTo.*
Additional Charges
Additional charges, plus applicable taxes, may also be assessed If you pay us with a check not
honored byyo.ur Financial Institutions, request copy of a docurrient.make delinqu.ent payments,
make charges which exceed your credit limit, requesta Cash Advance', of use your card for a
transaction at an automated teller machine, if such charges are not prohibited by law or regulation,
Notice: Checks returned NSF(Non-Sufficlent Funds) or USF(Uncollected Funds) are subject to
electronic ACH representmenL The annual fee shall be treated as a credit purchase for purposes of
calculating IntetestChatges, unless p(ohibited- by low,
Available Credit
The available creditspecified an the front of the statement displays the amount of your credit limit
available for purchases. Available creditaccounts for pending transactions that processed, but may
not have posted as of the statement date and therefore are not reflected on the statement;
Available Cash
The available cash specified on the front of the statement displays the amount of your cash.credit
limit available for cash advances. Available cash accounts for pending transactions that processed,
but may not have posted as of the statement date and therefore are not reflected an the statement
Closing Date
All transactions received a . fterthe closing date will appear on you. r nextstatement
In Case of Errors or inquiries About Your Bill
If you think your bill 1swrongM.or ifyou reed more information about a transaction onyour bill,
write uson a separate sheet of papetai the address indicated on the front of this statement after
the phrase'Mail Inquiries To:` as soon. as pass! ble.We must hear from you no latertban 60
days after wesentyou the first bill on whichthe error or problem appeared.You can telephone
us, but, doing $a will not preserve your rights. Calls re ivedino I
received our cardholder service center,
are periodically monitored to ensure quality service to our customers. Inyourietter, give us the
following information:
Your name and account number
The dollar amount of the suspected. error
Describe the errorrand explain,
I If you can, why you believe there is an error, If you need
more information, describe the item you are unsureabout.
You do not have to pay any amount in question while we are iInvestigating, butyou are still
obligated to pay the parts of your bill thatarenot In question, While we investigate your question,
we cannot roportyou as delinquent or take artyactionto collect.the amouhtyou qu . estion.
If you have a problem with the quality of goods or services that you, purchased with acredit card,
and You have tried in good faith to correct the problem with the merchan
, t, you may not, have to
pay the remaining amount due on the good orservices, You have this I
protectli.on only when the
purchase price was more than $50.00 and the purchase Was made in your home state or within
100 miles of your malling, address. (if we own or operate the merchant, or if we mailed you. the
advertisement for the property or services, all purchases are covered regardless of amount or
location of purchase,.)
Electronic Check ConversionjECK
When you provide check aspayment you authorize us to use Information from your' check to.
make a. onetime electforticfund transfer fromyour account in certain circumstances,suchas for
technical orprocessing reasons, we may process your p . ayment ascheck trans -action, I When we
use Information from your check to makean electronic fund transfer, fundsmay be Withdrawn from
your account as soon as the same day we receive your payment and you will not. receive your check
back from your financial Institution.
OIACI146-3-04/21121
Change of address? Please supply the new information in the boxes provided,
Street Amt Cardholdei's Signature
Stmet Add ms (cont.)
State ZIP Code
----------- — — -----
E-mail Address-
----- - - ---- - ----
Home Phone
...... Business Phone
We 4PPtTC14ft YOUrP4ftntrge and c*nt1nUW1Y strive to Pro Me quijjfty.s&wc#.
OA114600
THANK YOU FOR SHOPPING AT
Ag SLIPPly Are Hardware L
t 707-0026
Store 16881
4/ t40 VERM 674 SALE
AURA; INT EGG I X P 1„ $12.99
PfaQR'l I Ek , .5 EA
STAlf PRE QUART FES
1006470 EA. $6,59 EA
ACE BES1 BRUSH ANG -LE, I W59
5002175 1, E $16M E
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Aulthariz,ng Network: VISA
Bark card U50$ 42,30
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THANK YOU NEW HOPE SHELTER ADVOCATE
FOR YOUR PATRONAGE
c i CASH C,USTOMER MOSES) LAKrr
Costamer Copy
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lOffice S092fies
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007
8038
8021
81}72
7611
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$ 0.28
$ 4,35
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0.57
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2.35
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4,
42-30
WINDERMERE PROPERTY MANAGEMENT GRANT COUNTY, INC
.�'��.,td r Kar
tv ��,U�uggm
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n,ow
Reference, 2DO9-1280
Card #: *******#****8493
Card Type: Visa
Date'. 05/0112023
WINDERMERE PROPERTY MANAGEMENT GRANT COUNTY, INC WnAmre
324 S. Ash St. * Suite A - Moses Lake, WA 98837
(509) 765-5691
1. Residency and Financials
1.1 PARTIES
THE PARTIES TO THIS RESIDENTIAL LEASE, AGREEMENT ARE:
Landlord/Agent.- Windermere Property Management Grant County Inc.
Address: 324 S. Ash Street, Suite A, Moses Lake, WA, 98837
Telephone: 509-765-5691
Tenants)
(hereinafter referred to as "'Tenant" or 'Tenants,").
Other Occupants:
Co-signer
Liability of Tenants- All persons- who sign this Residential Lease Agreement (this "Agreement") as Tenants shall be 'ointly and severally
liable under the terms of this Agreement. The term '-Tenant" as used in this Agreement, shall refer to alltenantsidentified I the previous
in
subsection.
Substitution ofTenants. Unless otherwise agreed, this tenancyisrestricted to the above named tenants and other occupants. Prior written
consent of Landlord is required to substitute or increase tenants or occupants. Such. consent shall not be unreasonably withheld. Additional
or substitute tenants shall become additional signatories toy this Agreement.
Removal of Tenant. To be removed from this lease all listed Tenants must sign off, and the tenant being removed will be required. to sib
off having any claim to deposit refund, should there be one, in return for no longer having any financial responsibility to the terms of this
lease. 10
1.2 PROPERTY
Landlord leases the following property (the ""Premises"') to Tenants:
Real Property Address:
Portions, of Premises Not Included. If portions of the Priernises are not included as part of this Agreement then there will be a separate
addendum attached.
1.3 TERM
Term. The term of this Agreement shall begin on 05/01/2023 and end on 04/30/2024 (the "Term"") and thereafter on a month-to-month
tenancy upon the terms and conditions herein.
Early Possession. In the event the Tenant takes early occupancy, all. terms and conditions of this Agreement shall become effective at the time
of said occupancy. This includes, but is not limited to, rent and other amounts due to Landlord applicable to any
phor or early occupancy.
Tenant to take occupancy beginning: 05/01/2023
1.4 RENT
Amount. The monthly rental shall be $
Rent Income $1,300.40
Total; $1,300.00
errant Ledger
Tenants:
Mobile: (509) 750-2275
Property:
Status: Current
More in date: 05/01/2023
Move out date: —
Lease Expiration-, 04/30/2024
Beat. 1,300.00
Deposit Paid: 1,000.00
Date Payer
Description
Charges
Payments
Balance
Starting Balance
0.00
04/2012023
Application Fee Income
30.00
30.00
04120/2023
Credit Card Payment (Reference #FD71-57A0)
30.00
1 a'00
04127/2023
Application Fee Income
30.00
30,00
04/27/2023
Credit Card Payment( eference #8BF2-3B80)
30-00
0.00
04/28/2023
Mgmt Held Security Deposits - Move In Charge, Mg mt
11, 000,00
1,000.00
Held Security Deposits
04128/2023
Credit Card Payment (Reference #1 B20-3AE0)
I t000.00
0.00
06/01/2023
Rent Income - Move. in Charge-, Rent Income
11300.00
1,300.00
Q5/01/2023
Credit Card Payment (Reference #20-09-1280)
11300.00
0.00
Total 0.00
Created on 05/01/2023 Page I
County of Grant
35 C ST NW
P.0, Box 37
Ephrata WA 98823
Vendor; WASHINGTON TRUST BANK..
PO, BOX 2127
SPOKANE WA 99210-212.7
Document Number 'Purchase Order Number
�,f847-0-4/202-3
Description:
Visa Statement 04/20.23
Page I / 1
Invoice 0388742
Date 5/10/2023
Vendor `l Shipping Method Payment Terms ID
W—TB—CC---------t --"RET 30 M.,.._..._..,
Amount
$3,582.65
Subtotal
$31582.65
Mis-C
$0.00
Tax
$0.00
Fre fight
$0,00
Trade Discou ht
$0.00
Payment
0.
Total Due
$3,582.65
1146 LWG 3 7 1 230502 0 PAGE 1 OF 2 1 0 4833 0030 CX48 OIAC1146
Cardholder Name and Account NumberPage I oft
ELISA ADOLPHSEN _VISA
GRANT COUNTY
Washington Trust Bank
XXXX-XXXX-XXXX-9184
*W #A*.ngx- MCI
Remit Payment to:
WASHINGTON TRUST BANK
PO BOX 2127SPOKANE, WA 99210-2127
WASHINGTON TRUST BANK
PO BOX 2127
SPOKANE, WA 99210-2127
Please' include your account
number on your check.
ENew address, phone number or e-mail?
h..k the box to the lett and print changes on back.
WASHINGTON TRUST BANK
PO BOX 2127
SPOKANE, WA 99210-2127
'L Questions?
NJ! Mail In To,
P.O. BOX 2127 SPOKANE, WA 99210-2127 Call Customer Service: 800-78"578
Lost or Stolen Card: 800-788-4578
We appreciate your businesst
DUE 05. 7.23
Transactions
-Account Information
—#47
Reference
Account Summary
Amount
Statement Closing Date
05/02/2023
24492162X00129X11t1
Previous Balance
$320.00 -°`F
Credit Limit
$7,500.00
Payments and Credits
$0.00
Available Credit
$7,357,00
2469.21,62X326JP6GZ
FinAnce Charge(net)
$0.00
Cash Credit Limit
$0.00
249430031 S4AFKQHK
+ Purchases
$0.00
Available Cash
$0.00
2400641344ZMVPHKM
+ Cash Advances
$0.00
04/12
04/11
24455.0135447Y50PJ
+ Other Charges
WOO
04/16
04114
2424052388AL3DH2Y
New Balance
$0.00
04118
04/17
Payment Informao
FAMOUS FOOTWEAR.#3272 MOSES LAKE WA
$65.03 00_�
Payment Due Date: 05127/2023
04118
Minimum Payment Due, $0.00
New Balance. $0,00
Remit Payment to:
WASHINGTON TRUST BANK
PO BOX 2127SPOKANE, WA 99210-2127
WASHINGTON TRUST BANK
PO BOX 2127
SPOKANE, WA 99210-2127
Please' include your account
number on your check.
ENew address, phone number or e-mail?
h..k the box to the lett and print changes on back.
WASHINGTON TRUST BANK
PO BOX 2127
SPOKANE, WA 99210-2127
'L Questions?
NJ! Mail In To,
P.O. BOX 2127 SPOKANE, WA 99210-2127 Call Customer Service: 800-78"578
Lost or Stolen Card: 800-788-4578
We appreciate your businesst
Transactions
Post Date
Trans Date
Reference
Description
Amount
04104
04103
24492162X00129X11t1
CRAWFORD CONNECTIONS
$320.00 -°`F
New Balance
$0.00
HTTPSWVWV.CRAVWVA
04/04
04/03
2469.21,62X326JP6GZ
]N*ARROWHEAD SCIENTIFIC 913-8948388 KS
$2,383,22
04107
04106
249430031 S4AFKQHK
COSTO} WHSE #0112 EAST WENATC;HEWA*k
$216.99
04111
04/10
2400641344ZMVPHKM
ICP*AIM School and Gymnas509-7650452 WA
$100.00
04/12
04/11
24455.0135447Y50PJ
WAL-MART #2007 MOSES LAKE WA
$58.62
04/16
04114
2424052388AL3DH2Y
WSP BACKGROUND CHECKS 360-534-2109 WA
$11.00 .
04118
04/17
24153383Q2M6TQAGE
FAMOUS FOOTWEAR.#3272 MOSES LAKE WA
$65.03 00_�
04119
04118
24431063060Y8KXJQ
GOVTPERMITS/CERTIFICAT 855-642-2453 NC
$26.13<--
04/20
04/19
24492153D . T8Y18DBG
WF WAYFAIR3903090127 866-263-8325 MA
$292.67
04/21
04/20
24240523FBLGZL9*7A
CORNER ST. DONUTS LLC 5098551844 WAv
$1150
05102
05/01
24226383SBLHOATJN
WAL-MART#2007 MOSES LAKE WA <
$95-49-#'
05/02
05/02
00000000000000MPC,
TOTAL PURCHASES $3,582.65
TOTAL $3,582.65
'TOTAL FEES FOR THIS PERIOD
TOTAL INTEREST FOR THIS PERIOD
Remit Payment to:
WASHINGTON TRUST BANK
PO BOX 2127SPOKANE, WA 99210-2127
WASHINGTON TRUST BANK
PO BOX 2127
SPOKANE, WA 99210-2127
Please' include your account
number on your check.
ENew address, phone number or e-mail?
h..k the box to the lett and print changes on back.
WASHINGTON TRUST BANK
PO BOX 2127
SPOKANE, WA 99210-2127
'L Questions?
NJ! Mail In To,
P.O. BOX 2127 SPOKANE, WA 99210-2127 Call Customer Service: 800-78"578
Lost or Stolen Card: 800-788-4578
We appreciate your businesst
ELISA ADOLPHSEN
GRANT COUNTY
ATTN MICHELE JADERLUND
PO BOX 37
EPHRATA WA 98823-0037
00000000000000004'129570031 0291 347
--
Payment Due Date
May
Account Number xxxx-xxxx-xxxx-gl 84
S M T VY T F S
2 4 1 5_1 ra
New Balance
$0.00
7,8, 9 11 12 13
14 -15 16 1-77 18 1 !2n
Minimum Payment Due
NONE
4 195
211- .2 23 24 25 24
28 1 29 30 31 -
Amount,
Enclosed$
ELISA ADOLPHSEN
GRANT COUNTY
ATTN MICHELE JADERLUND
PO BOX 37
EPHRATA WA 98823-0037
00000000000000004'129570031 0291 347
1146 LWG 3 7 1 230502 0
Cardholder Name and Account Number
ELISA ADOLPHSEN
GRANT COUNTY
XX -?Cid -XX -9184
'AGE 2 OF 2 1 0 4833 0030 CX48 OIAC1146
IfISA Page 2 of 2
Finance Char a . alculatilon
Annual Percentage Rate (APR) is the annual interest rate on your account,
Type at Balance APR. Average DailFinance
charge Rernrtit
Balance
Balance
Purchases 17.99% (V) $9.010
$0.00 $0,99
Gash Advances 20.99% (V) $0.00
$0.00 $0.00
Days in Billing Cycle: 0 (V) = Variable Rate
See reverse side of page one for explanation of Finance Charge calculation, Credit Purchases
calculated using Method C. Gash
Advance Char es calculated using Method A.
FOR REBATE PROGRAM QUESTIONS, GALL 800-788-4578.
IMPORTANT INFORMATION
Terms and Conditions
Pfease refer to the disclosure prtiviously prowrided for the Terms and.Conditionsgoverning the
use of this account These Terms and Conditions may be amended or supplemented by separate
notices to you including any notices you have previously tecelved from us.
Credit Terms
The Interest Charge Calculation Method applicable to your: account for Cash Advances and Credit
Purchases of goods and services thatyou obtain through the use of your card is specified within tite
Interest Charge Calculation section of this statement and explained below,
Method A— The Interest Charge. on Cash Advances begins to accrue on the date you obtain the
Cash Advar}ce or the first day of the billing cycle in which it is posted to your account, whichever is
later, the Interest Charges for a billing cycle aro; cornputed by applying i;he daily periodic rate to
theaverage daily balance multiplied by the number of days in the billing cycle. Each daily :balance
is determined by adding to the. Previous Balance (the outstanding balance of your account at the
bqinrlinal of the billing cycle) any new Credit Purchases posted to your account and any new Cash
Advances received, and, subtracting any payments as received or credits as posted to your account,
bort excluding arty unpaid Interest. Charges or overlimit fees. Method G —Tbe Interest Charge on
Credit Purchases begins to accrete an thedate each is pasted to your account. To, avoid incurring
aro additional Interest Charge on the balance on Credit purchases reflected on this statement and
on any new Credit Pu rchases appearing on your nextstatement, you must pay the New Balance
shown on the reverse side on or before the Payment Due Date. The Interest Charges for a billing
cycle are computed by applying the daily periodic rate. to the average daily balance. multiplied by
the number of days in the billing cycle: Each daily balance is determined by adding to the Previous
Balance of Credit Purchases any new Credit Purchases posted to your account and subtracting any
Payments as received and credits as posted to your account, bort exdo. ding any unpaid Interest
Charges or overlimiI fees.
THE EFFECTIVE ANNUAL PE CE:NTACE RAFE WILL DIFFER FROM THE CORRESPONDING ANNUAL
PERCENTAGE PATES: IF CASH ADVANCE FEES OR DVERI.IMIT PEES HAVE BEEN INCLUDED.
Note.- If a variable rate plan is applicable to this account, the periodic rate may vary.
Payment Crediting
Payments received by S p.m. at the location specified on the front of the statementafter the
phrase "Remit Payment To:" will be credited as of the date: of receipt to the accountspecified on
the payment coupon. Payments ma.de in person by S po. during normal business hours, Monday
through Friday, at branch locations where such payrnents.areaccepted, will be treated as received
on the sante clay. Payments that do not conform to the requirements set forth on or with the
periodic statementle.g. rising payment stub, payment envelope other than as provided withyour statement, multiple checks or multiple coupons in the same envelope)may besubject to
delay In crediting, but shall be credited within days of recelpt._
Credit Balance
If there is a crredit balance due to you, you may request in writing a full refund of this creditbalance
at the address indicated on the front of the statement after the phrase "Mail Inquiries To,'
Additional Charges
Additional charges, plus applicable taxes, may also be assessed if you pay us with a. check not
honored by your Financial Institution, req saest acQpyof adocument, make delinquent payrrients,
make charges which exceed your credit limit, request Cash Advance, or use your card fora
transaction at an autornated teller machine, if such charges are not prohibited by law or regulation
Street A►ddr+ess
,Notice- Checks returned NSF(l on—Sr f-ficient Funds)or USF (Uncoil cted f ands) are subjectto
eiertronicACH representmenL The annual fee shall be treated as a credit purchase for purposes of
calculating Interest Charges, unless prohibited by law.
Available Credit
The available credit specified on the front of the statement displays the arnount of your credit limit
available for purchases. Available credit accounts for pending transactions that processed, but may
not have posted as of the statement date and therefore are not reflected'on the statement.
Available Cash
The availabfe.cash specified on the front ofthe statement displays the amount of your cash credit
limit available for cash .advances. Available cash accounts for pending transactions that processed,
but May not have. posted as of the statement date and therefore are not reflected on the statement.
Closing Date
All transactions recelved after the closing elate will appear on your next statement,
In Case of Errors or Inquiries About Your Bill
If you: thinly your bill is wrong; or if you need atone Information about a transaction on your bill;
write us on a separate sheet of paper at the address indicated on the front of this stateriiet't after
the phrase "Mail Inquiries To:" as soon as possible, We must hear from you rto later than by
days after we'sentyou the first bill on which the error or problem appeared, You can telephone
us, but doing so will not preserve your rights. Calls received in our cardholderse:rvice center
are periodically monitored to ensure, quality service to moor customers. in your letter, give us the
following inf€trrrtation
* Your name andactountriumber
* The dollar amount of the suspected error
+ Describe the.error and explain, i1yon, cant.why you believe there is an error, If you treed
more Inforit Mion, des 'ibe the item you are unsure about.
You do not, have to pay any amount ire question while we are investigating, butyou are still
obligated to pay the parts of your `bill that are, not in question, While we investigate your question,
we cannot report you as delinquentor take anyaction to collect the amount you question,
If you have a problem with the quality of goods or services.thatyi u ,purchased with a credit card,
and you have tried in good faith to correct the problem with the merchant, you may riot have to
pay the remaining amount dire on the good or services, You have this protection only when the
purchase price was more than $50.00 and the purchase was made in your home state or within
100 miles of your €Halling address. #If we own or operate the merchant, orifwe retailed you the
advertisement.forthe property or services, all purchases are covered regardless ofarmountor
location ofpurchase.i
Electronic Check Conversion ECK
When you provide a0eck as payment, you authorize us to use inforrnabon from your Ehetk to
make a one-time electronic fund transfer from your account, In certain 6rcumstances, such as for
technical or processing reasons, we may process your payment as a check transaction. When we
use information from your check to make an electronic fund transfer, fonds may be withdrawn from
your account as soon as the same day we receive you€ payment, and yarn Will not receive your check,
back, from yourfinancial institution,
01 ACt 146 - 3 - 04/21/21
Change of address? Please supply the newn irmati ll in the boxes provided,
Street Address (cont)
CardholdleASigmwre
city State ZIP Croke
i
E-mail Address
----------- -------
Home Phone Business Phone
We oPPrecl a ft your p tro>rroge gond contimtollystrive to provide +q aft swWee.
OA114600
Costco - PA system
office Supg1jes
a
8324
9*28
way
am
NZI
8072 7011
49.w f
zo
s
2,05
12.00
$ 5.06
40,14
3,60 2110
216 99
a
County of Grant
35 C ST NW
P.O. Box 37
Ephrata WA 98823
Vendor: WASHINGTON TRUST BANK..
PO BOX 2127
SPOKANE WA 99210-2,127
Document Number
.,0412023
bescription.,
Visa Statement 04/2023
Page I / 1
Invoice 0388774
Date 5/10/2023
Purchase Order Number VendorlD Shipping Method
........... Payment Terms ID
Subtotal
Misc
Tax
Freight
Trade Discount
Payment
Total Due
_'_LN -ET 30
Amount
$435t9O
$435.90
$0.00
$0.00
$0.00
$0,00
$0.00
$435.90
1146 LWG 3 7 1 230502 0 PAGE I OF 2 1 0 4833 0030 CX48 OIAC1146
Cardholder Name and Account Number Page 1 of 2
NEW HOPE AMAZON 111SA
GRANT COUNTY AUDITOR
" 11
illp XX"-XXXX-XXXX-9663
Win0on Trust and
*A# %4WVt41r;r=
L���W
Account Information
Questions?
#50
Transactions
Call Customer SeNice, 800-78$-4576
Post mate
L Account
I Referen
Statement Closing Date
Credit Limit
05/02/2023
Previous Balance
$0.00
Available Credit
$10,000-00
$10,000.00
Payments and Credits
$0.00
Cash credit Limit
$0.00
Finance Charge net)
$0.* 00
Available Cash
$0,00
+ Purchases
+ Cash Advances
$0.00
$0.00
$16.10
04/05
+ Other Char es
$romo
AMZN Mktp US*HS8ZP9AR1 Amzn.corTVbIIIWA
$32,09
New Balance
$0.00
2443106322DK75NEX
AMZN MKTP US*HJ8J054FO AMAMZN.COM/BILLWA
PLyment Information
---------
Payment Due Date.- 05/27/2023
24692163235HXOY5,T
Minimum Payment Due: $0,00 New Balance: .$0.00
Remit Payment to:
WASHINGTON TRUST BANK
PO BOX 2127.SPOKANE, WA 99210-2127
WASHINGTON TRUST BANK
PO BOX 2127
SPOKANE, WA 992102127
Please include your account
nt
number on your check.
New address, phone. number or e-mail?
L_4 Check the box to the left and pdnt tears on back.
WASHINGTON TRUST BANK
PO BOX 2127
SPOKANE, WA 99210-2127
Mail Inquiries To;
Questions?
Transactions
Call Customer SeNice, 800-78$-4576
Post mate
Trans Datece
..
I Referen
Description
Amount
04105
04/04
24692162Y328YW3LK
AMZN Mktp. US*HY2S I T2W82 Amzn,com/billWA
$22.23
04105
04/04
24692162Y32V25,BV6
AMZN Mktp US*HS3DC9JX1 Amzn.c,,onVbil[WA
$28.97
04/05
04/04
24692162Y32V3KZ31
AMZN Mktp US*HS6YU8HL0 Amzn.com/b11IWA
$16.10
04/05
04105
246021622332GAAKQ
AMZN Mktp US*HS8ZP9AR1 Amzn.corTVbIIIWA
$32,09
04/09
04/08
2443106322DK75NEX
AMZN MKTP US*HJ8J054FO AMAMZN.COM/BILLWA
$67.18-�-"
04/09
04/08
24692163235HXOY5,T
AMZN Mktp US*HS6S42572 Amzn-com/biIIWA
$84.53'
04111
04/10
2469216342XPQ4AEW
AMZN Mktp US*H.34PN9G40 Amz.n.conVbillWA
$16.89--0*0
04112
04/11
2443106352DYV66WN
AMAZON,COM*Hj5558HZ0 AMZNAMZN.COM/"BILLWA
04/12
04/11
2443106352D ZWFY2G
AMAZON COM,*HJ4ZO6HYO AMZNAMZN.COIVI1BILLWA
$14.57-4"
04/12
04111
2469.216352Y3NR91 K
AMZN Mktp US*HJ8EG8ZX1 Amzn.com/billWA
$39.01-"**
04/13
04/12
2469216362Z3YKJPV
AMZN Mktp US*HJ5UJ6GE1 Amzn.com/bIIlWA-
04/26
04/26
24692163L2ZR07KJM
AMZN Mktp US*HF9011 KBO Arnzn,com/billWA
$36.3'0 x.
04/26
.04/26
24692163L2ZR6Y9EN
AMZN Mktp US*HF8A89PZ2 Amzn.com/bJJIWA
$15.17 '
05/02
05/02
o0000000000000MPC
TOTAL PURCHASES $435.90
TOTAL . $435.90
TOTAL FEES FOR THIS PERIOD
TOTAL INTEREST FOR THIS PERIOD
Remit Payment to:
WASHINGTON TRUST BANK
PO BOX 2127.SPOKANE, WA 99210-2127
WASHINGTON TRUST BANK
PO BOX 2127
SPOKANE, WA 992102127
Please include your account
nt
number on your check.
New address, phone. number or e-mail?
L_4 Check the box to the left and pdnt tears on back.
WASHINGTON TRUST BANK
PO BOX 2127
SPOKANE, WA 99210-2127
Mail Inquiries To;
Questions?
P-0, BOX 2127 SPOKANE, WA 99210-2127
Call Customer SeNice, 800-78$-4576
Lost or Stolen Card-
800-788-4578
We appreciate your business!
Payment Due D
May
Account Number
XXXX-XXXX-XX"-9663
S M T W T F S
4 -_ 616
New Balance
$0.00
-L-L-L 10 .11
14 15 16 IT 18 1aJ1')n_.
Minimum Payment Due
NONE
21 22 23 24 25_ 2 10
28 29 30 1
Amount
Enclosed $
NEW HOPE AMAZON
GRANT COUNTY AUDITOR
ATTN MICHELE JADERLUND
PO BOX 37
EPHRATA WA 98823-0037
000000000000000041295700310296630
1146 LWG 3 7 1 230502 0 PAGE 2 OF 2 1 0 4833 0030 CX46 01AC1146
Cardholder Name and Account Number Page 2 of 2
NEW HOPE AMAZON
RANT COUNTY AUDITOR
XXXX-?C XX- -XXX-9663
Finance Charge Calculatlon
Annual Percentage Rate (APF) is the annual interest rate on your account.
Type of Balance APS
Average Dally .Finance Charge* to air n
P�I�'C1aS�:s� Q�v � BalanceBalance
?,99Io (V) $0.00 $0.00 $0.00
Cash Advances 20.99% V} $0.00 $0.00 $0.00
Days in Billing Cycle: 0 M = Vadat le Rate
See reverse side of page one for explanation of Finance Charge calculation. Credit Purchases calculated using Method C. Gash
Advance Char es calculated using Method A.
�..�.
FOR REBATE PROGRAM QUESTIONS, CALL 800-788-4578.
IMPORTANT INFORMATION
Terms and Conditions
Please refer to the disclosure Previously provided for the terms and Conditions governing the
use of this account. These terms and Conditions maybe amended or supplemented by separate
notices to you including any noticesydu have previously received from lis.
Credit Terms
This Interest Charge Calculation Method applicable to your account for Cash Advances: and Credit
Purchases of goods and sarvi�,es that you obtain through the use of your yard is specified r ftfrin Clic
Interest Charge Calculation section of this Statement and explained below:
Method A The Interest Charge on Cash Advances begins to accrue on the date you obtain the
Cash Advance or the first day of the billing cycle in which it is posted to.your account, whichever is
later, The Interest Charges for a billing cycle are computed by.applying the daily periodic rate to
the average daily balance multiplied by the number of days in the billing cycle. Each daily balance
is determined by adding to -the previous Balance (the outstanding balance of youraccountat the
beginning of the billing C*ycle) any new Credit Purchases posted to your account and any new Cash
Advances received, and subtracting any payments as received or credits as posted to your account,
but excluding any. unpaid Interest Chargers oroverlimit fees. Method 6 —The Interest Charge on
Credit Purchases begins to accrue on the date each is posted to your account, To avoid incurring
an additional Interest Charge an the balance ori C€edit Purchases reflected on this statement and
on any new Credit Purchases appearing On your next statement, you most pay the New Balance
shown on the reverse side on or before the Payrmnt Due Date. The Interest Charges fora billing
cycle are. c mputed by applying the dailyperiodic rate to the average daily balance multiplied by
the number ofdays in the billing cycle. Each daily balance is determined by adding to the Previous.
Balance of Credit Purchases any new Credit Purchases pasted to your account and subtracting any
payments as received and credits as posted to youraccount, butexcluding any unpaid Interest
Charges or overlim.it tees.
Ti c EF ECTIVE ANNUAL PERCENTAGE RATE WILL DIFFER FROM THE CORRESPONDING ANNUAL
PERCENTAGE RATES IF CASH ADVANCE FEES OR' OVERiIMIT FEES HAVE BEEN INCLUDED.
Note: Its variable rate plait is applicable to this account, the periodicrate may vary.
Payment Crediting
Payments recoivod by 5 P,mt at tate location specified on the front of the statement after the
phrase "Remit Payment To:" will be credited as. of the date of receipt to the account specified on
the payment coupon. Payments made in person by 5 pm. during normal business hours, Monday
through Friday, at branch locations vrhere such payrrte.nts are accepted, will be treated as received
on the same day, Payments that do nottonform to the requirements set forth on or with the
periodicstaternent(e.g. € i singpayment stub, payment envelope otfie€than as provided with
your statement, multiple checks or multiple coupons in the same envelope) may be subject to
delay to crediting, but shall be credited within 5 days of receipt.
Credit Balance
If there isa credit balance due to you, you may requestin writing a full refund of this Credit balance
at the address Ind Bated on the f ro of the statement alter the phrase "Dail Inquiries To.'
Additional Chanes
Additional charges, plus applicable taxes, may also be assessed if you pay tis with a check not
humored byyour Eiriantial Institution, requesta Copy of document, make de:lrn4 cent Py a merits
make charges which exceed your credit Inst, regi:este t*aslt Advance, or use your card for a
transaction at an automated teller machine, if such charges are not prohibiter by law or, €egttlatTorr.
Notice: Checks returned NSE(Non-Sufficient Funds)or USF (Uncollected Funds) are subject to
electronicAChf represent€nent-The annual fee rshail be Created as a credit purchase for purposes of
calculating Interest Charges, unless prohibited bylaw,
Available Credit
The available credit. specified on the front of the statement displays the amount of your Credit limit
available for purchases. Available credit accounts for pending transactions that processed, but may
not have pasted as of the statement data and therefore are not reflected on the statement,
Available Cash
The avallable cash specified on the front of the statement displays the amountof your cash credit
Breit available for Lash advances. Available cash accounts for peridirig transactions that processed,
but may not have posted as of the statement date and therefore are not reflected on the statement.
Closings Date
All transactions received afterthe closing, date will appear on your aextstatemerit.
In Case of Errors or Inquiries About Your Bill
If you think your bill is wrong, or if you need tore information about.3 transaction on your bill,
write us on a separate sheet of paper at the address indicated on the from of this statement after
the phrase "Mall Inquiries To:" as soon as.possible, We must hear from you no later than 60
days after we sent you the first bill on which the arror or problern appeared. You, can telephone
us, but doing so will notp�reserve your rights, Calls received in our tardholderservice center
are periodically monitored to ensure quality service to our Customers.In your letter, give us the
following information
* You;r name and account number
The dollar amount of the suspected error
Describe the error and explain, if you cart, why you believe there is an error. if you creed
more Information,describe the item you are unsure about.
You do not have to pay airy amount in question while we ace investigating, butyou are still
obligated to Tray the partsof your bill thatare notin. question. While we investigate your question,
we cannot repo€t you as definquent or take any action to collect tate arnountyou questi6n,
If you have a problem with the quality of goods or services that you purchased with a credit card,
and you have tried in good faith to Correct the problem with the ,merchant, yoy may not have .to
pay tho remain ing amount due on the good or services, You have'this Prot Ictioti t�nly when the
purchase price was snore chart "50, 00 and the purchase was made in your hurme;state or velthin
100 miles of your trailing address. (If we own or. operate the merchant, o1 if we ,mailed you tete
advertise mentfor the property oiserivices, all purchases are covered regardless ref amountor
location ofpurchase.)
Electronic Check Conversion/ECl�
When yort provide a check as payment, you authorize us to.use information from your checkto.
make a one-time electronirrfund transfer iron) yoruraccount. In certaincircrtrmstances, such as for
technical or processing reasons, we may process your payment as a check transaction. where we
use Information from your check to snake an electronic fund tragi for, funds may be withdrawn from
Your account as sons as the same day we receive your payment, artd you will not receive your chef
backtrorn your financial institution,
01A,C11 4 - 3 Y 041211.
Charge of address? Please supply the neer information in the boxes provided,
StreetAddress Cardholder's Signature
Street Address (cont.)
City state ZIP Code
--
E-mail Address
Home Phone Business Phone
Wit aPP#Vckft Yourpraftt7ago and condnualty strive to provide quality service.
amazon.com
Paid By: Grant County
Placed By: Alyce Barrientoz
Order Placed* April 6, 2023
PO number: Office Supplies - NH
Am- azon..com order number: 113-5745306-8667461
Order Total: $84.53
Not Yet Shipped
-- ------ ---
Ron"
Items Ordered
20f: LectroFan Nigh Fidelity Price
White Noise Machine with 20 Unique Non-LoopinFad Whind Sleep Timer
Ct on—Looping anWhite Noise Sounds
$31.99
Sold by: Amazon LwJLQ�) a
i�, J1 j(gkjA___
Q
Business Price
Condition: New
1 Of: Temdan Magnetic Case for iPhone 12 Case for Phone 12 Pro Case,[Compatible with Magsafej[2 Pcs Glass Screen Protectorj $13.99
[Not Yellowing] Slim Thin Shockproof Phone Case Cover 6. 1 "-Cloar
Sold by: Boomingus(s!a11ff_4_rQfiLQ)
Condifion.- New
I
Shipping Address:
ALYCE BARRIENTOZ
311 W 3RD AVE
MOSES LAKE, WA 98837-1905
United States
Shipping Speed:
FREE Prime Delivery
PaYMen't information
Payment Method:
Visa I Last digits: 9663
To view the status of your order, return to -cLrcj-er Stj
Imm-a-fly -
Item(s) Subtotal:
$77,97
Shipping & Handling:
$0.00
Total before tax:
$77.97
Estimated Tax:
$6.56
C�0—ndifllfflla-9–f -U-6-Q IEdYaQY tick @ 1996-.2020, Amazon.com, Inc.
VeL
Grand Total: $84.53
County of Grant
35CSTNW
P.O. Box 37
Ephrata WA 98823
Vendor -
CHAD LINDSTROM
1155 MICHAEL LANE
EAGLE POINT OR 97524
Document Number Purchase Or Number
b4242--3- —DG —L---
6e-i�ripiio
Ctlent EFA
Page I / 1
Invoice 0387620
Date 4/25/2023
Vendor
h_ fl ng Method
IppiPayment Terms ID
Amount
$1,400.00
Subtotal.
$1x400.00
$0.00
Tax
$0.00
Freight
$0.00
Trade Discount
$0.00
Payment
Total Due
-1'
e$11,400-OWO
GRANT COUNTY
New Hope/Kids Hope Kids Hope
3q M
. . . . . . . . . . .
PROMISE TO PAY
Date 4/24/23
Claimant: Chad Lindstrom
Post Office Address:. -J
Ais ll bills must be itemized in detail on thbla k or 'Itemized list attached herewith. When submitting claims for
n
rent be sure to specify dates claim is intended to cover.
For Submission, for Payment -
ISSUED: Return Voucher To:
Pe-bbie Long Grant County
New Hope/Kids Hope Ad6cate New Hope/Kids Hope
311 W Third Avenue Moses Lake,
WA 98837
I hereby Certify on Honor, that thegoods, merchandise, material or service charged for in the above bill have been
furnished as herein cha riged.
DATE: 4/24/23
CANNOT BE USED FOR ALCOHOL, TOBACCO,
PRE -PAID OR GIFT CARDS,
See- AiWcbed Lattff,—..,
Printed Claimant Name
Signature
Cheone: Ej Mail Dayment to above address
ck
21 Claimant will'ck up
IP -1 p2ym ent at
Ne
Vouchers received by 12 o0 pm, Wednesday will have payment available the following Thursday.
10-- ---- OWN- -1
-00. 011.0
EMERGENCY FINANCIAL ASSISTANCE
FORM SIGNED? YES C✓�NO[:]
FUNDING: HB1277
Tenant Pays $1,300.00 per mon.th for rent. Tenant is currently late forApn*l 2023 rent and has
incurred $100.00 in late fees. Total owing for April's rent is $1400,00,
Chad Lindstrom
1155 Michael Lane
Eagle Point, Or. 97,524
County of Grant
35 C ST NW
P.O. Box 37
Ephrata WA 98823
Vendor: MELVA LANE LLC
DBA: QUALITY INN
449 MELVALAN E
MOSES LAKE WA 98837
Document Number Purchase Order Number
—59* -0 2 8 �5
6,eiii7lp-66-n
Emergency Shetter
Page 111
Invoice 0389379
Date 5/23/2023
VendorlD Shfpping Method Payment Terms ID
—AET 30
Amount
$153.85
Subtotal
$153.85
misc
$0.00
Tax
$0"00
Freight
$0,00
Trade' Discount
$0.00
Payment
d�Q
Total Due
$153.85
Quality -
INN
By CHOICE HOTELS
NEW HOPE
HOPE., NEW
311 W 3RD
MOSES LAKE, WA 98837
Post Date
3/14123
3/14/23
3/14/23
3114/23
3/1.5/23
3/15/23
3/15/23
3/15/23
3115123
3/16/23
Description
Pet Charge
State Tax
Room Charge
State Tax
Direct Bill
Pet Charge
State Tax
Room Charge
State Tax
Direct Bill
Room Charge
State Tax
Direct Bill
Pet Charge
Quality Inn (WA255j
449 Melva Lane
Moses Lake, WA 98837
(509) 765-8886
GM-WA256@choicehotels.com
Comment
#106 HOPE, NEW
#106 HOPE, NEW
Account.* 859990285
Date: 5/18/23
Room: 106 LMLO Ns
Arrival Date: 3/14/23
Departure Date: 3/16123
Check In Time: 3/14/23 6:07 PM
Check Out Time-. 3/16/23 8:32 AM
Rewards Program ID,:
You were checked out by: sgille
You were checked In by: Irosco
Total Balance Due*- 0.00
Folio Summary 3114/23 - 3/16/23
With this rate you are able to earn valuable
Choice Privileges points!
X
IS CHOICE
p * ileges.
4EWAR01
Amount
10.00
0.99
60.00
5.94
(76.93)
10-00
0,99
59.99
5,94
(76.92)
119.99
13.86
20.00
Balance Due: 0.00
(153.85) will be billed to: Account 2277219
NEW HOPE, 604 West Third, Suite B, Moses Lake, WA 98837
You could be earning free nights at Choice hotels and other great rewards. Join Choice
Privileges today by stopping by the front desk, or to on to
www.choicehote.is-com/choice-privileges.
allty
I N N
13Y CHOICE HOTELS
NEW HOPE
HOPE, NEW
311 W 3RD
MOSES LAKE, WA 98837
Post Date Description
Quality Inn (WA255)
449 Melva Lane
Moses Lake, WA 98837
(509) 765-8886
GM-WA255@choicehot'els.com
Comment
Account: 859990285
Data: 5/18/23
Room: 106 WCONS
Arrival Date.* 3/14/23
Departure Data: 3/16/23
Check In Time: 3/14/23 6:07 PM
Check Out Time: 3116/23 8:32 AM
Rewards Program ID:
You were checked out by: sgille
You were checked in by. Irosco
Total Balance Due: 0.00
Amount
0.00
Folio Summary 3114/23 -1/116123
0.00
Balance Due: 0.00
With this rate you are able to earn valuable
Choice Privileges points!
F]
x
4S CHOICE
privil6ges.
114WARPS
You could be earning free nights at 'Choice hotels and othergreat rewards. Join Choice
Privileges todayst b oppng i
y by thefront desk, or logging on to
www.cho"lcehotels-com,/choice-privileges.
Client Shelter Form
Shelter/Hotel:
Hotel
Hotel Name/Room in Shelter: Quality In
Date In:
3/x.4/202.3
Date Out.-
Program*
DV
Review Shelter Guidelines: Yes
Invoice Turned In: No
Client (First Initial &
Last Name):
Year of Birth:
2002
Client ID,*, GML26173
Case ID:
661904
NCA Trak, 2022-344
Secondary #1 YOS:
2018
Gender: Male
Secondary #2 YOSO
Gender:
Secondary #3 YOB,,
-----
Gender:
Secondary #4 YOB:
Gender:
Secondary #5 YOBi#
Gender:
Secondary #6 Y084
Gender:
Previous Living Situation 7.: Rental by client, no ongoing subsidy
Where did client exit to?:
Payment Grant,V
Comments:
County of Grant
35 C ST NW
P.O. Box 37
Ephrata WA 98823
Vendor: MELVA LANE LLC
DBAO, QUAILITY INN
LANE
449 MELVA LNE
MOSES LAKE WA 98837
Document Number Purchase, OrderNumber
870451141
Description:
Emergency S.hetter
Page I / 1
Invoice 0389388
Date 5/23/20'23
VendorlD Shipping. Method
Subtotal
Misc
Tax
Freight
Trade Discount
Payment
Total Due
NET
Payment Terms ID
Amount
$197.82
$197.82
$0.00
$0.00
$0.00
$0.00
:$197
!!.82
With this rate you are able to earn valuable
Choice Privileges points!.
(197482.) Will be billed to., Account 2277219
NEW HOPE, 604 West Third, Suite B, Moses Lake, WA 98837
X
OHIE
privileges -
REWARDS
You could be earning free nights at Choice hotels and other great rewards. Join Choice
Privileges toda y- by sto in by he front desk or logging- - on, t
pp g t 0
wwwachoicehotels-com/choice-privileges.
Quality Inn (WA255)
Account: 870451141
Date: 5/22/23
449 Melva Lane
Room: 203 WCONS
Quality-
Mo S*es Lake, WA 98837
Arrival Date: 5/19/23
INN
(509) 765-8886
Departure Date: 5/22/23
BY CHOICE HOTELS
GM-WA255cox choicehote[S.COMCheck
In Time, 5119/23 1'1:26 PM
NEW HOPE
Check Out Time: 5/22/2311:08 AM
HOPE, NEW
Rewards Program ID:
You were checked out by: CARRED
Moses LakeWA 98837
You were checked in by: mram
Total Bal an.co.Due': 0.00
Post Date
Desc6ptiloh
comme, t
n
-5/19/23
Room Charge
. ,
#203 HOPE, NEW
Am.ouiit
5/19/23
State Tax
60.00
5/20123
Room Charge
#203 HOPE, NEW
5.94
5/20/23
State Tax
60.00
5/21/23
Room Charge
#203 HOPE, NEW
5.94
5/21/23
State Tax.60.00
5/22/23
Direct Bill
5.94
(197.82)
Folio. Summary 5/19123
5/22123
Room Charge
State Tax
180.00
Direct Bill
17-82
(197.82)
BalanceDue:
0.00
With this rate you are able to earn valuable
Choice Privileges points!.
(197482.) Will be billed to., Account 2277219
NEW HOPE, 604 West Third, Suite B, Moses Lake, WA 98837
X
OHIE
privileges -
REWARDS
You could be earning free nights at Choice hotels and other great rewards. Join Choice
Privileges toda y- by sto in by he front desk or logging- - on, t
pp g t 0
wwwachoicehotels-com/choice-privileges.
- -Cur- -rent Past 30 --- -Days Past 60 Days Past 90 mays
86..90-.00100i 1,055.04 2i 9.79 0.00
NEW HOPE
604 West Third, Suite B
Moses Lake, WA 98837
Inver
Da te
3/212023
3/1512028
311.6/2023
3121/2023
312612~023
41362023
4146202.3
411212023
4114/2023
411812023
51862023
51'11/2023
5112/2023
51-15120.23
5/1512023
511512923
5/'1612023
NEW,HOPE
HOPE, NEW
HOPE, NEW
HOPE, NEW
HOPE, NEW
NEW ; O E
NES, HOPE
NEW RODE
NEW HOPE.
NEW DOPE
HOPE, NEW
HOPE, NEW
HOPE, NEW
HOPE, NEW
HOPE, NEW
HOPE, NEW
HOPE, NEW
Amount Due Due Date
2145.73 Upon Receipt
Company Prefile Number: 2277219
Page I of 1
Past 120 mays
0,00
Statement of Account
This is a reminder of your obligation*
Please call (509) 765-8886 if you should have any que tions regarding` this.
statement,
NEW HOPE
504 West Third, Suite S
Moses Lake, ilvA 98537
Acs
857786893
859990285
859990285'
860885430
861781445
862745876--""
6
863193807
8831.33055
864529078-o'
868376752
868373315
85872;2484
868722484
869606542
869441647 ,,,~
869434694
86041401 ,
.Account Tz
Guest
Guest
Guest
Guest
Guest
Guest
Guest
Guest
Guest
Guest
Guest
Guest.
Guest
Guest
Guest
Guest
Guest
Quality Inn
449 Melva Lane
Quatity-Moses Lake WA 98837
INN
byCHOCSHOY GM-WA255@cho'lcehotels.com
choicehotels.com
In e
tuber
56723023
66894287
66916889
66972869
670405.00
67149139
67154321
67255101
67282934
67333450
67602127
67642317
6765792.4
87806427
67696432
67696437
67707010
Amount
65.94
76.93
75~92
65.94
55.94
197.82
65.94
593.46.
131.88
65.04
131.88
U0
263.75
65.93
197.82
197.82
263.76
redt
0.00
0.00
O..Oo
(65.94)
0.00
0.00
0,00
0.00
0..00
0.:00
0.00-o-
0.010
0.00
0, 00,
0.00 pci
0.00 - f.'Cl
0.00
Total Due:
Amount Due Due Date -------------
21461.73 Upon Receipt
Amount Clue
2,461.73
X68.94
7,6.92--
0.00 '. `
65.94..E
197.82
65.94
593.46
131.88
65.94
131.88"'
0.00---
263,75,,-
65.93
.00263,75,,-
55.93
107.82
197MO;
263,76,
2,461.7'3
This is a reminder for your records. If payment
has already been submitted, please accept
our thanks,, elle appreciate your business!
Quality Inn
Quality
449 Melva Lane
INN
Idoses Lake, WA 98837
$Y 04WCE 540'res
Telephone. (509) 755-8886
Fax (509) 766-0779
GM-WA255@choicehotels.com
- -Cur- -rent Past 30 --- -Days Past 60 Days Past 90 mays
86..90-.00100i 1,055.04 2i 9.79 0.00
NEW HOPE
604 West Third, Suite B
Moses Lake, WA 98837
Inver
Da te
3/212023
3/1512028
311.6/2023
3121/2023
312612~023
41362023
4146202.3
411212023
4114/2023
411812023
51862023
51'11/2023
5112/2023
51-15120.23
5/1512023
511512923
5/'1612023
NEW,HOPE
HOPE, NEW
HOPE, NEW
HOPE, NEW
HOPE, NEW
NEW ; O E
NES, HOPE
NEW RODE
NEW HOPE.
NEW DOPE
HOPE, NEW
HOPE, NEW
HOPE, NEW
HOPE, NEW
HOPE, NEW
HOPE, NEW
HOPE, NEW
Amount Due Due Date
2145.73 Upon Receipt
Company Prefile Number: 2277219
Page I of 1
Past 120 mays
0,00
Statement of Account
This is a reminder of your obligation*
Please call (509) 765-8886 if you should have any que tions regarding` this.
statement,
NEW HOPE
504 West Third, Suite S
Moses Lake, ilvA 98537
Acs
857786893
859990285
859990285'
860885430
861781445
862745876--""
6
863193807
8831.33055
864529078-o'
868376752
868373315
85872;2484
868722484
869606542
869441647 ,,,~
869434694
86041401 ,
.Account Tz
Guest
Guest
Guest
Guest
Guest
Guest
Guest
Guest
Guest
Guest
Guest
Guest.
Guest
Guest
Guest
Guest
Guest
Quality Inn
449 Melva Lane
Quatity-Moses Lake WA 98837
INN
byCHOCSHOY GM-WA255@cho'lcehotels.com
choicehotels.com
In e
tuber
56723023
66894287
66916889
66972869
670405.00
67149139
67154321
67255101
67282934
67333450
67602127
67642317
6765792.4
87806427
67696432
67696437
67707010
Amount
65.94
76.93
75~92
65.94
55.94
197.82
65.94
593.46.
131.88
65.04
131.88
U0
263.75
65.93
197.82
197.82
263.76
redt
0.00
0.00
O..Oo
(65.94)
0.00
0.00
0,00
0.00
0..00
0.:00
0.00-o-
0.010
0.00
0, 00,
0.00 pci
0.00 - f.'Cl
0.00
Total Due:
Amount Due Due Date -------------
21461.73 Upon Receipt
Amount Clue
2,461.73
X68.94
7,6.92--
0.00 '. `
65.94..E
197.82
65.94
593.46
131.88
65.94
131.88"'
0.00---
263,75,,-
65.93
.00263,75,,-
55.93
107.82
197MO;
263,76,
2,461.7'3
This is a reminder for your records. If payment
has already been submitted, please accept
our thanks,, elle appreciate your business!
Page 1 /1
Invoice 0389380
Date 5/23/2023
County of Grant
35 C ST NW
P.O.. Box 37
Ephrata WA 98823
Vendor: MELVA LANE LLC
DBA.- QUAILITY INN
449 MELVA LANE
MOSES LAKE WA 98837
Document Number Purchase Order -Number Vendorl!)
861781445 Shipping Method Payment Terms ID
Description: QUALI NET 30
Emergency Shelter Amount
$65-94
Subtotal
$65-94
Mix
$0.00
Tax
$0.00
Freight
$0.00
Trade Discount
$0,00.
Payment
$0 0
.0
Total Due
Quality -
INN
By CHOICE HOTELS
NEW HOPE
HOPE, NEW
311 W 3RD
MOSES LAKE, WA 98837
Post Date
Description
3/25/23
Room Charge
3125/23
State Tax
3/26/23
Direct Bill
Room Charge
State Tax
Direct Bill
Quality Inn (WA255)
449 Melva Lane
Moses Lake, WA 98837
(509) 765-8886
GM-WA255@choicehotels.com
Comment
#208 HOPE, NEW
Account, 861781445
D0te'. 5/18/23
Room, 208 WCONS
Amival Date. 3/25/23
Departure Date* 3126/2.3
Check In Time: 3/25/23 7:49 PM
Check Out Time, 3/26/23 9:29 AM
Rewards Program ID:
You were checked out by: sgille
You were checked in by., jmacke
Total Balance Due: O.00
Amount
60.00
&94
(65.94)
Folio Summary 3125/23 - 3126123
With this rate you are able to earn valuable
Choice Privileges pointsl
X
CHOICE
privileges_
R rE WA NO I
60.00
5.94
(65.94)
Balance Due: 0.00
(65-94) will be billed to: Account 2277219
NEW HOPE, 604 West Third, Suite B , Moses Lake, WA 98837
You could be earning free nights at Choice hotels and other great rewards. Join Choice
Privileges today by stopping . by the front desk,, or logging on to
www.choicehotels-com/choice-privileges.
Quality -
INN
By CHOICS HOTELS
NEW HOPE
HOPE, NEW
311 W 3RD
MOSES LAKE, WA 98837
Post, Date Deseription
Quality Inn (Wg255)
449 Melva Lane
Moses Lake, WA 98837
(509) 765-8886
GM-WA255@choicehotels.com
Comment
Account: 861781445
Date: 5118/23
Room: 208 WCONS
Arrival Date: 3/25/23
Departure Date: 3126/2-3
Check In Time: 3/25/23.7:49 PM
Check Out Time: 3/26/23 91*29 AM
Rewards Program ID:
You were checked out by: sgille
You were checked in by: jmacke
Total Balance Due,* 0.00
Amount
Folio Summary 3/25123 - 3/26/23
0.00
Balance Due: 0.00
With this rate you are able to earn valuable
Choice Privileges points!
x
:CHOICE
Privileges-
114WAV100
You It be earning free nights at Choice hotels and other great rewards. Join Choice
Privileges today by* stopping by the front desk, or logging on to
www.choicehote.is-com/choice-privileges.
Client Shelter Form
shelter/Hotel: —Hotel - HotelName/Room in Shelter: Quality In
Date In: 3/25/2023 Date Out:3/26/2-023
Program: DV — ----- Review Shelter Guidelines: Yes
Invoice Turned in: No
Client (First Initial & Last Name):
Year of B.11rth.- 1984
Client ID: ZZ29183
Case ID: 691722 NCA Trak: 2023-186
Secondary #1Y'OB: 2006
Secondary #2 YOS: 2016
Secondary #3 YO 8:
Secondary #4 YOB:
Secondary #5 YOB:
Secondary #6 of
Gender: Male
Gender: Female
Gender:
Gender:
Gender.
Gender-:
Previous Living Situation?: Staying or living W/family
Where did client exit toy. Data not collected
Payment Grant.
Comments: Client was passing thru Grant County, needed a safe place to sleep before
continuing to final destination
County of Grant,
35 C ST NW
P.O. Box 37
Ephrata WA 98823
Vendor: MELVA LANE LLC
,DBA*- QUAILITY INN
449 MELVA LANE
MOSES LAKE WA 98837
Document Number
Purchase Order Number
868722484
. . ...... QUALI
Description:
Emergency Shelter
Page I / 1
Invoice 0389386
Date 5/23/2023
Vendor- lid Shipping Meth
o+ Payment Terms ID
NET 30
Amount
$263.75
Subtotal
$263.75,
misc
$0.00
Tax
$0.00
Freight
$0.00
Trade Discount
$0. . 00
Payment
Total Due
C$263.75
NEW HOPE
HOPE, NEW
604 W 3RD AVE STE B
MOSES LAKE, WA 98837
Post Date
Quality Inn (WA255)
Comment
449 Melva Lane
Quality-
Moses Lake, WA 98837
INN
(509) 765-8886 1
sir ci4oice HarELS
GM-WA255@choicehotels.com
NEW HOPE
HOPE, NEW
604 W 3RD AVE STE B
MOSES LAKE, WA 98837
Post Date
Descrilption
Comment
5/8/23
Room Charge
#307 HOPE, NEW
5/8/23
State Tax
5/9/23
Room Charge
#307 HOPE, NEW
5/9/23
State Tax
5/10/23
Room Charge
4307 HOPE, NEW
5/10/23
State Tax
5/11/23
Direct Bill
5/11/23
Room Charge
#307 HOPE, NEW
5/11/23
State Tax
5/12/23
Direct Bill
Adjustment
5/12/23
Direct Bill
Room Charge
State Tax
Direct Bill
Account: 868722484
Date: 5/18/23
Room: 307 WCONS
Arrival Date: 5/8/23
Departure Date,- 5/12/23
Check In Time: 518/23 4:21 PM
Check Out Time-, 5/12/23 7:1 o AM
Rewards Program ID:
You were checked out by: imacke
You were checked in by: carred
Total Balance Due: 0.00
Folio Summary 5/8/23 - 5/12/23
With this rate you are able to earn valuable
Choice Privileges points!
X
O CHOICE
privilegesv.
*FWAIM11
Amount
60.00
5.94
60.00
5494
60.00
5.94
(197.82)
5999
5.94
197-82
(263.75)
239.99
23.76
(263.75)
Balance Due: 0.00
(263.75) will be billed to: Account 2277219
NEW HOPE, 604 West Third, Suite B , Moses Lake, WA 98837
You could be earning free nights at Choice hotels and other great rewards. Join Choice
Privileges today by stopping by the front desk, or logging on to
www.cho*icehotels.com/choice-privileges.
Shelter/Hotel:
Date In:
Program:
DV
Hotel
_5/8/2023
Client (First Initial & Last Name):
Client shelter Form
Hotel Name/Room in Shelter: Quality 307
Date Out:
Review Shelter Guidelines: Yes
Invoice Turned In:
Year of Birth:
...... 1999 Client ID: GML16148
Case ID:
696475 NCA Trak** 2023-60
Secondary #1 YOB*
Gender,0
Secondary #2. YOB:
Gender:
Secondary #3 YOBip
Gender:
Secondary #4 YOB:
Gender. -
Secondary #5 YOS:
---- Gender:
Secondary #6 YOB:
Gender:.
Previous Living Situation?: Data notcollected
Where did client exit to?:
Payment Grant:
Comments:
Client has been chronically homeless for several years, currently
sleeping in car or couch surfing
County of .Grant
135 C ST NW
P.O. Box 37
Ephrata WA 98823
Vendor-, MELVA LANE LLC
DBA: QUAILITY INN
449 MELVA LANE
MOSES LAKE WA 9.8837
Document Number Purchase order Number
863133055
Description*
Emergency Shelter
LI
Vendor ID
Page 111
Invoice 0389383
Date 5/23/2023
Shipping Method Payment Terms ID
NET 30
Amount
$593.46
Subtotal
$593.46.
Misc
$0,00
Tax
$0.00
Freight
$0.00
Trade Discount
$0.00
Payment
Total Due
1 .
000
(!!9!30-005
J�j��
Quality Inn (WA2
Account, 863133055
Date: 5/1 8/23
449 Melva Lane
Room: 107 WCONS
a "
Moses Lake, WA 98837
Ardval Date: 413/23
INN
(509) 765-8886
Departure Date: 4/12/23
by C 1 HOTELS
GM-WA255@chol'cehotels. com
Check In Time: 23 101-51
AM
NEW HOPE
Check Out Time: 4/12/23 10,-37
AM
NEW,HOPE
Rewards Program ID:
306 BEECH STE A
You were checked out by: sgille
MOSES LAKE, WA 98837
You were checked in by, Irosco
Total Balance Due: 0.00
Post DateDescription
Comment
Amount
4/3123
Room Charge
#107 NEW, HOPE
60.00
4/3/23
State Tax,
5.94
4/4/23
Room Charge
#107 NEW HOPE
60.00
4/4123
State Tax
5.94
4/5/23
Room Charge
#107 NEW, HOPE
60.00
4/5123
State Tax
5494
4/6/23
Room Charge
#107 NEW, HOPE
60.00
4/6/23
State Tax
5.94
4M23
Room Charge
#107 NEW, HOPE
60.00
4/7123
State Tax
5.94
4/8/23
Room Charge
#1107 NEW, HOPE
60.00
4/8123
State Tax
5.94
4/9/23
Room Charge
#107 NEW, HOPE
60.00
4/9123
State Tax
5.94
4/10/23
Room Charge
#107 NEW, HOPE
60.00
4/10/23
State Tax
5,94
4/11/23
Room Charge
#107 NEW, HOPE
60.00
4/11/23
State Tax
894
4/12/23
Direct Bill
(593.46)
Folio Summary 4/3/23 - 4112123
Room Charge
540.00
State Tax
53.46
Direct Bill
(593.46)
'Balance Due.*
0.00
J�j��
With this rate you are able to earn valuable
Choice Privileges points!
(593.46) will be billed to: Account 2277219
NEW HOPE, 604 West Third, Suite B, Moses Lake, WA 98837
mvCHOICE
privileges...
ORMA001
You could be earning free nights at Choice hotels and other rat rewards. Join Choice
Privileges today by stopping by the front desk, or logging on to
.
Quality -
INN
BY CHOIce HOTELS
NEW HOPE
NEW,HOPE
306 BEECH STE A
MOSES LAKE, WA 98837
Post Date Desediption
Quality Inn {WA255j
449 Melva Lane
Moses Lake, WA.98837
(509) 765-8886
GM-WA255@choicehotels,com
Comment
Account: 863133055
Date: 5/18/23
Room: 107 WCONS
Arrival Date: 4/3/23
Departure Date: 4/12/23
Check In Time: 41312310:51 AM
Check Out Time., 4/12/23 101:37 AM
Rewards Program ID:
You were checked out by., sgille
You were checked in by: frosco
Total Balance Due: 0.00
Amount
0.00
Folio Summary 413/23.4112/23
0.00
Balance Due: 0.00
With this rate you are' able to earn valuable
Choice Privileges points!
x
CHOICE
privileges,
f1CWA"$
You could be earning free nights at Choice hotels and other great rewards. Join Cho*
Privileges today by stopping by the front desk, or to on to ice
WWW*choicehotels.com/chol*cemoprivileges,
Page 1 /1
Invoice 0389382
Date 5/23/2023
County of Grant
35 CST NW
P.O. Box 37
Ephrata WA 98823
Vendor-, MELVA LANE LLC
DBA: QUAILITY INN
449 MELVA LANE
MOSES LAKE WA 98837
Document Number
Purchase Order Number 'VendorlD Ship ing Method
Payment Terms ID
063193807
6 1 QUALI
-----------
Description,
Emergency Shelter Amount
$65.94
Subtotal
$65-94
Misc
$0100
Tax
$0.00
Freight
$0.00
Trade Discount
$0.00
Payment
Total Due
6:5
q.94
Folio Summary 4/3123 - 414123
Room Charge
State Tax
Direct Bill
With this rate you are able to earn valuable
Choice Privileges points!
X
41CHOICE
privileges-
RtWARVS
Account: 863193807
Date: 5118/23
Room.- 208 LMCONS
Arrival Date: 4/3/23
Departure Date: 4/4/23
Check In Time; 4/3123 5.*07 PM
Check Out Time: 414123 5:19 Al
Rewards Program ID:
You were checked out by amitch
You were checked in by: 9preb!
Total Balance Due: 0.00
Amount
60.00
5.94
(65.94)
60.00
5.94
(65,94)
Balance. Due: 0.00
(65.94) will be billed to: Account 2277219
NEW HOPE, 604 West Third, Suite B , Moses Lake, WA 98837
You could be earning free nights at Choice hotels and other -great rewards, Jo - in Choice
Privileges today by stopping by the front desk, or logging on to
www.choicehotels.com/choice.,Prl*vileges.
Quality Inn (A25}
449 Melva Lane
u a t i -
Moses Lake, WA 98837
INN
(509) 765-8886
By CH04CE HOTELSGM-WA255@choicehotels.com
NEW HOPE
NEW,HOPE
306 BEECH STB A
MOSES LAKE, WA 98837
Post Date Description
Comment
4/3/23 Room Charge
#208 NEW, HOPE
4/3/23 State Tax
4/4/23 Direct Bill
Folio Summary 4/3123 - 414123
Room Charge
State Tax
Direct Bill
With this rate you are able to earn valuable
Choice Privileges points!
X
41CHOICE
privileges-
RtWARVS
Account: 863193807
Date: 5118/23
Room.- 208 LMCONS
Arrival Date: 4/3/23
Departure Date: 4/4/23
Check In Time; 4/3123 5.*07 PM
Check Out Time: 414123 5:19 Al
Rewards Program ID:
You were checked out by amitch
You were checked in by: 9preb!
Total Balance Due: 0.00
Amount
60.00
5.94
(65.94)
60.00
5.94
(65,94)
Balance. Due: 0.00
(65.94) will be billed to: Account 2277219
NEW HOPE, 604 West Third, Suite B , Moses Lake, WA 98837
You could be earning free nights at Choice hotels and other -great rewards, Jo - in Choice
Privileges today by stopping by the front desk, or logging on to
www.choicehotels.com/choice.,Prl*vileges.
Folio Summary 4/3/23 - 4/4/23
With this rate you are able to earn valuable
Choice Privileges points!
x
Of CHOICE
privileges.
*tWA*0$
Account: 863193807
Date: 5118123
Room: 208 WCONS
Arrival Date: 413/23
Departure Date: 4/4/23
Check In Time: 4/3/23 5:07 PM
Check Out Time: 4/4/23 5:19 AM
Rewards Program ID:
You were checked out by: a.,mitch
You were checked In by: gprebi
Total Balance Due: 0.00
Amount
0.00
0.00
Balance Due: 0.00
You could be earning free nights at Choice hotels and other great rewards. Join Choice
Privileges today by stopping by the front desk, or logging on to
www.choicehotels-comichoice-privileges.
Quality Inn (WA255)
449 Melva Lane
Quality-
Moses Lake, WA 98837
INN
(509) 765-8886
BY CHOICE HOTELS
GM.WA255@choicehotels.com
NEW HOPE
NEW, NOPE
306 BEECH STE A
MOSES LAKE, WA 98837
Post Date Description
Comment
Folio Summary 4/3/23 - 4/4/23
With this rate you are able to earn valuable
Choice Privileges points!
x
Of CHOICE
privileges.
*tWA*0$
Account: 863193807
Date: 5118123
Room: 208 WCONS
Arrival Date: 413/23
Departure Date: 4/4/23
Check In Time: 4/3/23 5:07 PM
Check Out Time: 4/4/23 5:19 AM
Rewards Program ID:
You were checked out by: a.,mitch
You were checked In by: gprebi
Total Balance Due: 0.00
Amount
0.00
0.00
Balance Due: 0.00
You could be earning free nights at Choice hotels and other great rewards. Join Choice
Privileges today by stopping by the front desk, or logging on to
www.choicehotels-comichoice-privileges.
County of Grant
35 CST NW
P.O. Box 37
Ephrata WA 98823
Vendor: MELVA LANE LLC
D8A*, QUAILITY INN
449 MELVA LANE
MOSES LAKE WA 98837
DocuMent Nur Purchase Order Number VendorlD
V-627-4587�----'-'---' 6 — -
UALI
Description: ......
Emergency Whetter
Page 1 /1
Invoice 0389381
Date 5/23/2023
.................. ...
Shtppling Meth+ Paym,e—nt Terms ... I , D
MnnMew
Amount
$197.82
Subtotal
Misc
Tax
Freight
Trade Discount
Payment
Total Due
$197.82
$0.00
$0.00
$0.00
Quality,
INN
13Y CHOICE HOTELS
NEW HOPE
NEW, HOPE
306 BEECH STE A
MOSES LAKE, WA 98837
Post Date
3/31/23
3/31/23
411/23
4/1 /28
4/2/23
4/2/23
4/3/23
Description
Room Charge
State Tax
Room Charge
State Tax
Room Charge
State Tax
Direct Bill
Room Charge
State Tax
Direct Bill
Quality Inn (WA255J
449 Melva Lane
Moses Lake, WA 98837
(509) 765-8886
GM-WA255@.choicehotels.com
Comment
#306 NEW, HOPE
#306 NEW, HOPE
#306 NEW, HOPE
Account: 862745876
Date: 5/18/23
Room: 306 WCONS
Arrival Date: 3/31/23
Departure Date: 4/3/23
Check In Time: 3/31/23 5:42 PM
Check Out Time: 4/3/23 10:39 AM
Rewards Program ID:
You were checked out by-, Irosco
You were checked in by: imacke
Total Balance Due: 0.00
Folio Summary 3/31123 - 4/3/23
With this rate you are able to earn valuable
Choice Privileges points!
Amount
60.00
5.94
60.0 0
5.94
60.00
6.94
(197,82)
180.00
17.82
(197.82)
Balance Due: 0.00
(197.82) Will be billed to: Account 2277219
NEW HOPE, 604 West Third, suite B, Moses Lake, WA 98837
X
CH I E
4W
privileges,
You could be earning free nights at Choice hotels and othergreat rewards. Join Choice
Privileges today by stopping by the front desk, or logging on to
www.choicehotels-com/cho*lce-privileges.
Quality -
INN
By CHOICE HOTELS
NEW HOPE
NEW, HOPE
306.13EECH STE A
MOSES LAKE, WA 98837
Post Date Description
Quality Inn (WA255)
449 Melva Lane
Moses Lake, WA 98837
(509) 765-8886
GM,WA255@choleehotels.com
Comment
Account: 862745876
Date: 5/18/23
Room: 306 WCONS
Arrival Date: 3/31/23
Departure Date: 4/3/23
Check In Time: 3131/23 5:42 PM
Check Out Time: 4/3/23 10:39 AM
Rewards Program ID:
You were thecked out by: Irosco
You were checked in by: imacke
Total Balance Due: 0.00
Amount
0.00
Folio Summary 3/31123 - 4/3/23
0.00
Balance Due: 0.00'
With this rate you are able to earn valuable
Choice Privileges points!
x
OCHo E
prilvileges.
rMWA*9$
You could be eaming free nights at Choice hotels and other great rewards. Join Choice
P.rivile.ges today- by stopping by the front desk, or logging on to
ww . w-cho.*Icehotels,com/choice-privileges,
Client Shelter Form
Shelter/Hotel:
.-HotelHotel
Name/Room in Shelter: Quality Inn
Date In:
3/31/2023
Date Out:
rain
CV
Review Shelter Guidelines: Yes
Invoice Turned In:
Client (First Initial
Last Name):
Year of Birth.-
1986
Client ID: GML12888
Case ID:
692195
NCA Trak: 2023-194,
Secondary #1 YOBW
2007
Gender: Male
Secondary #2 YOB:
Gender:
Secondary #3 YOS:
Gender:
Secondary #4 YOSO
Gender#
Secondary #5 YOB:
Gender:
Secondary #6 YOB:
Gender:
Previous Living Situation?:
Where did client exit to'?:
Payment Grant:
Comments:
Staying or living w/fam*11y
County of Grant
3.5 C ST NW
P.O. Box 37
Ephrata WA 98823
Vendor: MELVA LANE LLC
DBA: QUAILITY INN
449 MELVA LANE
MOSES LAKE WA 98837
Document Number Purchase Order Number
86
----
-------5376752
Description.-
Emergency Shelter
Page 1 /1
Invoice 0389385
Date 5/23/2023
VendorD Shipping Method
Payment Terms ID
—'NET 30
Amount
$ 65.94
Subtotal
$65.94
Misc
$0.00
Tax
$0.00
F r e 113- 'n -rL
$0.00
Trade Discount
$0.00
Payment
Total Duo(03�-5.94
(a
Quality -
INN
BY CHOICE HOTELS
NEW HOPE
NEW HOPE
306 BEECH STE A
MOSES LAKE, WA 98837
Post Date
Description
4/17/23
Room Charge
4/17/23
State Tax
4/18/23
Direct Bill
Room Charge
State Tax
Direct Bill
Quality Inn (WA255)
449 Melva Lane
Moses Lake, WA 98837
(509) 765-8886
GM-WA255@choicehotels.com
Comment
#215 NEW, HOPE
Account: 865376752
Date.- 5/18/23
Room: 215 WCONS
Arrival Date: 4/17/23
Departure Date: 4/18/23
Check In Time,
0 4/17/23 7.*02 PM
Check Out Time: 4/181/23 10:28 AM
Rewards Program ID;
You were checked out by: sgille
You were checked in by: imacke
Total Balance Due: 0.00
Amount
60.00
5.94
(65:94)
Folio Summary 4/17123 - 4118123
With this rate you are able to earn valuable
Choice Privileges pointsl
X
41CHOICE
privi'leges.
REWARDS
60.00
5.94
(6-5.94)
Balance Due: 0.00
(65,94) will be billed to'. Account 2277219
NEW HOPE, 604 West Third, Suite B, Moses Lake, WA 98837
You could be earning free nights at Choice hotels and other great rewards. Join Choice
Privileges today by stopping by the front desk, or logging on to
www. choicehotels - com./choice-privi leg es.
Quality -
INN
By CHOICE HOTELS
NEW HOPE
ISE W,HOPE
306 BEECH STE A
MOSES LAKE, WA 98837
Post Date DeSc6pt,lon
Quality Inn (WA255)
449 Melva Lane
Moses Lake_, WA 98837
(509) 765-8886
GM.WA255@choicehotels.COM
Comment
Account: 865376752
Date: 5/18/23
Room: 215 WCONS
Arrival Date: 4117/23
Departure Date: 4/18/23
Check In Time: 4/17/23 7:02 PM
Check Out Time-. 4/18/23 10:28 AM
Rewards Program ID:
You were checked out by: sgille
You were checked in by: jmacke
Total Balance Due: 0.00
Amount
0.00
Folio Summary 4/17/23 * 4/18/23
J o
Balance Due: 0.00
With this rate you are able to earn valuable
Choice Privileges points!
x
CHOICE
privileges.
*EWA001
You could be earning free nights at Choice hotels and other great rewards. Join Choice
Privileges today by stopping by the front desk, or logging on to
www.choicehotels.com/choice-privileges.
Client Shelter Form
Shelter/Hotel.- Hotel/Motel Hotel Name/Room in shelter: Quality Inn
Date ln:4/17/2023 Date Out: 8/18/2020
Program: DV
Review Shelter Guidelines: XY / EIN
Invoice Turned In: E3Y/ xN El N/A
Client (First initial & Last narne).,,
Year of bilrth.*1982
Client ID:
Case I.
Secondary #1
Click or tap to enter a date.
Choose an Item,
Secondary #3
t,o .1
Uckor tap to enter a date,
Choose an item,
Secondary #5
Click, or tap to enter a date.
Choose at) Item.
GW05648
694544
Notes.,, Notes,
Where did client exit to?, Don't Know
Secondary #2
Click, or tap to enter a, date,
p ft
choosi--_j ff, _
Secondary #4
"*Nck or to to enter a date.
rhoose an ReM,
Secondary #6
Click or tap to enter a date.
(..'hoose an "Itern.
County of Gran*
t
35 C ST NW
P.O. Box 37
Ephrata WA 98823
Vendor: MELVA LANE LLC
DBA: QUAILITY INN
449 MELVA LANE,
MOSES LAKE WA 98837
Document Number Purchase Order Number
- - - - - -- - ---------------
857786893
Description:
Emergency Shelter
Page I /I
Invoice 0389378
Date 5/23/2023
VendorID ShippintMethod ----- - -
Payment Terms ID
Amount
$65.94
Subtotal.
Misc
Tax
Freight
Trade Discount
Payment
Total Due
$65.94
$0.00
$0.00
$0.00
$0.00
t
Quality
INN
BY CHOICE HOTELS
NEW HOPE
NEW, HOPE
306 BEECH STE A
MOSES LAKE, WA 98837
Post Date
3/1/23
3/1/23
3/2/23
Quality Inn (WA255j
449 Melva Lane
Moses Lake, WA 98837
(509) 765-8886
GM-WA255@choicehotels.com
Account: 857786893
Date: 5117123
Room: 311 Lr CONS
Arrival Date: 311/23
Departure Date: 3/2/23
Check In Time: 3/1/23 7:03 PM
Check Out Time: 3/2/23 10.*45 AM
Rewards Program ID:
You were checked out by: sgille
You were checked in by.4 jmille
Total Balance Due: 0.00
Description..
Comment Amount
Room Charge
#311 NEW, HOPE 60. 00
State Tax
5,94
Direct Bill
(65..94)
Folio sur mary 311/23 -3/2123
Room Charge
60.00
State Tax
5.94
Direct Bill
(65.94)
Balance Due: 0.00
With this rate you are able to earn valuable
Choice Privileges points!
(65.94) will be billed to-, Account 2277219
NEW HOPE, 604 West Third, Suite 8, Moses Lake, WA 98837
X
O CHOIC * E
fle
rivi
p i ges.
a6mRog
You could be earning free nights at Choice hotels and other great rewards. Join Choice
Privileges today. stopping by the front desk, or logging on to
www.choicehotels.com/ch.oice-privileges,
Qual
INN
By CH010a HOTIELS
NEW HOPE
NEW,HOPE
306 BEECH STE A
MOSES LAKE, WA 98837
Post Date Description
Quality Inn (WA255)
449 Melva Lane
Moses Lake, WA 98837
(509) 765-8886
GM-WA255@choicehotels.com
Comment
Follo Summary 311/23 - 3121.23
With this rate you are able to earn valuable
Choice Privileges points!
x
CHOICE
0
Privileges.
RMAROS
Account: 857786893
Date: 5/17/23
Room: 311 WCONS
Arrival Date: 3/1/23
Departure Date.- 3/2/23
Check In Time: 3/1/23 7:03 PM
Check Out Time: 3/2/23 10:45 AM
Rewards Program ID. -
You were checked out by: sgille
You were checked in by: jmille
Total Balance Due.- 0.00
Amount
0.00
0.00
Balance Due: 0.00
(65.94) will be billed to: Account 2277219
NEW HOPE, 604 West Third, Suite B, Moses Lake,
WA 98837
You could be earning free nights at Choice hotels and other great rewards. Join Choice
c
Privileges today by stopping by the front desk, or logging on to
www.choicehotels-com/choice-privileges.
Shelter/Hotel: Hotel
Date In: 3/1/2023
Program: DV
Client (First Initial & Last Name):
Yearof Birth: 1999
Case ID: 688913
Secondary #1 Y08: 2022
Secondary #2 YOB:
Secondary #3 YOB*
Secondary #4 YOB.
Secondary #5 YOB:
Secondary #6 YOB:
Client Shelter Form
Hotel Name/ oto in Shelter: Quaility Inn
Date Out. 3/2/2023
Review Shelter Guidelines: Yes
Invoice Turned In:
Client ID.- GML12RRO
NCA Trak: 2023-125
Gender: Male
Gender:
Gender:
Gender.
Gender:
Gender:
Previous Living Situation?*
Staying or living /family
Where did client exit to?:
Payment Grant:
comments:
County of Grant
35 C ST NW
P.O. Box 37
Ephrata WA 98823
Vendor,-- MELVA LANE LLC
DBA: QUAILITY INN
449 MELVA LANE
MOSES LAKE WA 98837
Document Number -------TP—ur&hs—egirder 'Number
Page 1 / 1
Invoice 0389387
Date 5/23/2023
Vendor -11) I Shipping Method
Payment Terms ID
tk-
_j,
Description,
Emergency Shelter Amount
$197.82
Subtotal.
fisc
Tax
Freight
Trade Discount
Payment
Total Due
$197.82
$0.00
$0,00
$0.00
$0.00
ell �970.8'1)
(;I
Qual
INN
BY CHOICE HOTELS
NEW HOPE
HOPE, NEW
UNKNOWN
Moses Lake, WA 98837
Post Date
5/15/23
5/15/23
5/16/23
5/ 16/23
5/17123
5/17/23
5/18123
Quality Inn (WA255j
449 Melva Lane
Moses Lake, WA 98837
(509) 765-8886
GM-WA255@choicehotels.com
Account: 869788423
Date: 5/18/23
Room: 104 WCONS
Arrival Date: 5/15/23
Departure Date: 5/18/23
Check In Time.* 5/15/23 1:54 PM
Check Out Time:
Rewards Program 1D. -
You were checked out by:
You were checked in by: lrosco
Total Balance Due.- 0.00
Description
Comment
Room Charge
#104 HOPE, NEW
Amount
State Tax
60.00
Room Charge
#104 HOPE, NEW
5.94
State Tax,
60-00
Room Charge
#104 HOPE, NEW
5.94
State Tax
60-00
Direct Bill
5.94
(197.82)
Folio Summary 5115123 - 5/18/23
Room Charge
State Tax.180.00
Direct Bill
17-82
(197-82)
Balance Due: 0.00
With this rate you are able to earn valuable
Choice Privileges points!
X
CHOICE
' i
privileges,
AFEWAk"
(197.82) will be billed to: Account 2277219
NEW HOPE, 60-4 West Third, Suite B, Moses Lake, WA 98837
You could be earning free nights at Choice hotels and other great rewards. Join Choice
Privileges today by stopping by the front desk, or logging on to
www.choicehotels-com/choice-privileges.
Ayyi
Shelter/Hotel: Hotel
Date In: 5/15/2023
Program: CV
I.
Client (First Initial & LastN.am,.,'M,,
Year of Birth: 1987
Case ID: 692882
Secondary #1 YOB: 2008
Secondary #2 YOB*- 2010
Secondary #3 YOB: 2.014
Secondary #4 YOB*
Secondary #5 YOB:
Secondary #6 YOB:
Previous Living Situation?:
Where did client exit to?:
Payment Grant:
Comments:
Client Shelter Form
Hotel Name/Room in Shelter: Quality Inn
Date Out:
Review Shelter Guidelines:
Invoice Turned in:
Client ID: ML2 309
NCA Trak: 2023-202
Gender: Male
Gender: Female
Gender: Male
Gender:
Gender:
Gender:
Yes
County of Grant
35 CST NW
P ..0. Box 37
Ephrata WA 98823
Vendor: MELVA LANE LLC
DBA: QUAILITY INN
449 MELVA LANE
MOSES LAKE WA 98837
Document Number Purchase Order Number
Desctiption,*
Emergency Shelter
Page I / 1
Invoice 0389384
Date 5/23/2023
VI
'fender Shfpping Method
Subtotal
MISC
Tax
Freight
Trade Discount
Payment
Tota I Due
Payment Terms ID
30
Amount
$131.88
$131.88
$0.00
$0.00
$0.00
$0.00
$07
$131.88
C)
or
Qua[ 0
. Ity.
INN
BY CHOICE HOTLS
NEW HOPE
NEW, DOPE
306 BEECH STE A
MOSES LAKE, WA 98837
Quality Inn (WA255)
449 Melva Lane
Moses Lake, WA 98837
(509) 765-8886
GM.WA255@choicehotels.com
Account: 864529078
Date: 5/18/23
Room,* 107 WCONS
Arrival Date: 4/12/23
Departure Date'. 4114/23
Check In Time. 4/12123 10.'39 AM
Check Out Time: 4/14/23 9:42 AM
Rewards Program ID:
You were checked out by: sgille
You were checked in by: sgille
Total Balance Due,* 0.00
Post Date
Description
Comment
Amount
4/12/23
Room Charge
#107 NEW, HOPE
60.00
4/12/23
State Tax
5.94
4113/23
Room Charge
#107 NEW, HOPE
60.00
4/13/23
State Tax
5.94
4114/23
Direct Bill
(131.88)
Folio Summary 4112123 - 4114123
Room Charge
120,00
State, Tax
11-88
Direct Bill
(131.88)
Balance Due: 0.00
With this rate you are able to earn vA luable
Choice Privileges points!
X
CHOICE
Privileges,
Raw -knot
(131.88) will be billed to: Account 2277219
NEW HOPE, 604 West Third, Suite 8 , Moses Lake, WA 98837
You could be earning free nights.at Choice hotels and other great rewards. Join Choice
Privileges today by stopping by the front desk, or logging on to
www,choicehotels.com/choice-pri*vileges.
Qual
INN
8Y CHOIC5 HOTELS
NEW HOPE
NEW, MOPE
306 BEECH STE A
MOSES LAKEt WA 98837
Quality Inn (WA255)
449 Melva Lane
Moses Lake, WA. 98837
(509)765-8886
GM.WA255@choicehotels.com
Post Date Description Comment
Account: 864529078
Date: 5/18/23
Room: 107 WCONS
Arrival Data: 4/12/23
Departure Data: 4/14123
Check In Time: 4/1212810:89 AM
Check Out Time: 4/14/23 9'-42 AM
Rewards Program ID'.
You were checked out by: sgille
You were checked in by: sgille
Total Balance Due: 0.00
Amount
0.00
Folio Summary 4/12/23 - 4/14/23
-0. 00
Balance Due: 0.00
with ith this rate you are able to earn valuable
Choice Privileges points!
x
4+ICE
Privileges.
You could be earning free nights at Choice hotels and other great rewards. Join Choice
Privileges today by stopping by the front desk, or logging on to
www.choicehotels-comichoice-privileges.
She Shelter
Date In: 4/3/2023
Program: DV
Client Shelter Form
HotelNa M-e/Roomin Shelter: Quality Inn
Date Out:
Review shelter Guidelines: VAr.
Where did client exit to?:
Payment Grant:
Comments: He is actively working with Hopesource and Housing Authority while he
is sheltered
Invoice Turned In.,
Client (First Initial & Last Name),
Year of Birth: 1953
Client ID: GML33085
Case ID: 692232
NCA Trak: 2023-195
Secondary #1 YOB:
Gender:
Secondary #2 YOS:
Gender:
Secondary #3 YOB:
Gender:
Secondary #4 YOB:
Gender:
Secondary #5 YOB:
Gender:
Secondary #6 YOB:
Gender
Previous Living Situation'?*Sta-
0
y ing or living w/family
Where did client exit to?:
Payment Grant:
Comments: He is actively working with Hopesource and Housing Authority while he
is sheltered
County of Grant
35 C ST NW
P.O. Box 37
Ephrata WA 98823
Vendor.. 4-1 MELVA LANE LLC
DBA: QUAILITY
449 MELVA LANE
MOSES LAKE WA 98837
Document Number
860885430 -KC
P n*
Emergency Shelter
Purchase Order Number I VendorID
Page I / 1
Invoice 0385011
Date 3/21/2023
hi pin Method Payment Terms ID
N ET 30
Amount
$65.94
Subtotal
$65.94
misc
$0.00
Tax
$0.00
Freight
0.:60
Trade Discount
$0.00
Payment
$0.00
Total Due
$65.94-�
Quality -
INN
BY CHOICE NOTELS
NEW HOPE
HOPE, NEW
604 West Third, Suite B
Moses Lake, WA 98837
Post Date
Descid ption
3120/23
Room Charge
3/20/23
State Tax
3/21/23
Direct Bill
Room Charge
State Tax
Direct Bill
Quality Inn (WA255)
449 Melva Lane
Moses Lake, WA 98837
(509) 765-8886
GM-WA255@choicehotels.com
Comment
#107 HOPE, NEW
Account: 860885430
Date: 3/21/23
Room: 107 WCONS
Arrival Date: 3/20123
Departure Date: 3/21/23
Check In Time: 3/20/23 8:40 PM
Check Out Time: 3/21/23 9:07 AM
Rewards Program ID:
You were checked out by: sgille
You were checked In by: jmacke
Total Balance Due: 0.00
Amount
60.00
5.94
(65.94)
Folio Summary 3/20123 - 3/21/23
With thi's rate you are able to earn valuable
Choice Privileges points!
X
UCHOICE
privileges-
KWARDS
60.00
5.94
(65.94)
Balance Due-, 0.00
(65.94) will be billed to: Account 2277219
NEW HOPE, 604 West Third, Suite B , Moses Lake, WA 98837
You could be earning free nights at Choice hotels and other great rewards. Join Choice
Privileges today by stopping by the front desk, or logging on to
www.choicehotels-com/choice,,prl*vileges.
Client Shelter Form
Shelter/Hotel: Shelter Hotel Name/Room in Shelter: Quality Inn 107
Date In: -------- - 3/20/2023 Date Out* 3/21/2023
It
Program: DV Review Shelter Guidelines': Yes
Invoice Turned In:
Client (First Initial & Last Name):
Year of Birth: 1987
Case ID: 687357
Secondary #1 YOB:
Secondary #2 YOB*
Secondary #3 YOB:
Secondary #4YB,-
Secondary
4YOB,-
Secondary #5 YOBO
Secondary #6 YOB:
Client ID: GML28293
NCA Trak: 2023-75
Gender:
Gender:
Gender:
Gender:
Gender,
Gender,
Previous Livin.g Situation?,
Data not collected
-moo"
Where did client exit to?, Staying or living w/family
Payment Grant: 99#61
9 ou
Lo -
Comments: Put on Bus to Portland to reunite with family.
County of Grant
35 CST NW
P.O. Box 37
Ephrata WA 98823
Vendor-, MELVA LANE LLC
DBA: QUAILITY INN
449 MELVA LANE
MOSES LAKE WA 98837
Document Number Purchase Order Number
86 8 3 73315 -AT
Description:
Emergency Shetter
Page 1 /1
Invoice 0388749
Date 5/10/2023
Vendor ID Shipping Method Payment Terms ID
NET 30
Amount
$131.88
Subtotal
Misc
Tax
Freight
Trade Discount
Payment
Total Due
$131.88
$0.00
$0.00
$0.00
$0.010
$131.88
!F
Quality
INN
Sy CHOIC5 HOTELS
NEW HOPE
HOPE, NEW
311 W 3RD
Moses Lake, WAS 988.37
Post Date
5/6/23
5/6/28
5/6/23
5/6/23
5/7/23
5/7/23
5/7/23
5/7123
5/7/23
5/7123
5/8/23
Quality Inn (WA255)
449 Melva Lane
Moses Lake, WA 98837
(509) 765-8886
GM-WA255@choicehotels.com
Description
Room Charge
State Tax
Safe w/ltd Warranty
State Tax
Room Charge
State Tax
Safe w/ltd Warranty
State Tax
Room Charge
State Tax
Direct Bill
Room Charge
State Tax
Direct Bill
Safe int/ltd Warranty
Comment
#320 MOPE, NEW
Adjustment
Adjustment
Adjustment
Adjustment
#320 HOPE, NEW
Folio Summary 5/6/23 - 518123
With this rate you are able to earn valuable
Choice Privileges points!
X
C1i010E
privileges,
OPWA*01
Account, 868373315
Date: 518123
Room: 320 WCONS
Arrival Date.- 516/23
Departure Date., 5/8/23
Check In Time: 516/23 11:25 AM
Check Out Time:
Rewards Program ID:
You were checked out by:
You were checked in by: CARRED
Total Balance Due: 0.00
Amount
100.76
9.98
1.50
0,15
(40.76)
(4.04)
(1-50)
(0.15)
60.00
5,94
(131.88)
120.00
11.88
(131.88)
0.00
Balance Due: 0.00
(131,88) will be billed to: Account 2277219
NEW HOPE, 604 West Third, Suite B, Moses Lake-, WA 98837
You could be earning free nights at Choice hotels and other great rewards,, Join Choice
Privileges today by stopping by the front desk, or logging on to
www.choicehotels.com/choice.-privileges.
Shelter/Hotel: Hotel
Date In: 5/6/2023
Program: CV
Client (First Initial & Last Name):
Year of Birth: 1985
Casell). 696424
Secondary #1 YOB* 2014
Secondary #2 YOB: 2017
Secondary #3 YOB:
Secondary #4 YOB:
Secondary #5 YOB:
Secondary #6 YOB:
Client Shelter Form
J Graham
Hotel Name/Room in Shelter: Quality Inn
Date Out, - -------- 5/8/2023
Review Shelter Guidelines: Yes
Invoice Turned In: Yes
Client ID: GML28316
NCA Trak: 2023-259
Gender: Female
Gender: Male
Gender:
Gender:
Gender.
Gender:
Previous Living Situation.?,.- Staying or living w/friend
Where did client exit to?: Rental by client w/RRH or equivalent Subsidy
Payment Grant: CV
Comments: Homeless non intimate partner CSV. Referred to Hopesource
Hopesource took over sheltering client and kids for 2 weeks,
County of Grant
35 C ST NW
P.O. Box 37
Ephrata WA 98823
Vendor: MELVA LANE LLC
DBA: QUAILITY INN
449 MELVA LANE
MOSES LAKE WA 98837
Document Number Purchase Order Number
Num
be
RS
De -script'
Emergency Shelter
Page 1 / 1
Invoice 0389175
Date 5/17/2023
VendorID, Shipping Method --------
Payment Terms ID
ALI NET 30
Amount
$65.93
Subtotal
Mise
Tax
Freight
Trade Discount
Payment
Total Due
$65.93
$0.00
$0.00
$0.00
$0,00
$0.00
65.9
Room Charge
State Tax
Direct Bill
With this rate you are able to earn valuable
Choice Privileges points!
X
4S CHOICE
privilegerS.
ItEWAM4
59490
5.94
---- - (65.93)
Balance Due: 0.00
(65.93) will be billed to: I Account 2277219
NEW HOPE, 604 West ThirdI
SU'te 8 , Moses Lake, WA 98837
You could be earning free nights at Choice hotels and othergreat rewards. Join Choice
Privileges today by stopping by the front desk, or logging on to
www.choicehotels-com/choice-privileges,
Quality Inn (WA 55
Account., 869606542
Date: 5/15/23
449 Melva Lane
Room: 104 WCONS
Quality
Moses Lake, WA 98837
Arrival Date.- 5/14/23
INN
(509) 765-8886
Departure Data: 5/15/23
BY CHOICE HOTELS
GM-WA255@choicehotels.com
Check In Time* 5/14/23 219 PM
NEW HOPE
Check Out Time'. 5/15123 11:06 AM
HOPE, NEW
Rewards Program ID'.
311 W 3RD
You were checked out by: macke j
Moses Lake, WA 98837
You were checked in by: eveens
Total Balance Due: 0.00
59.99
5/14/23 State Tax
5/15/.23 Direct Bill
5.94
(65-93)
Room Charge
State Tax
Direct Bill
With this rate you are able to earn valuable
Choice Privileges points!
X
4S CHOICE
privilegerS.
ItEWAM4
59490
5.94
---- - (65.93)
Balance Due: 0.00
(65.93) will be billed to: I Account 2277219
NEW HOPE, 604 West ThirdI
SU'te 8 , Moses Lake, WA 98837
You could be earning free nights at Choice hotels and othergreat rewards. Join Choice
Privileges today by stopping by the front desk, or logging on to
www.choicehotels-com/choice-privileges,
With this rate you are able to earn valuable
Choice Privileges points!
Account: 869606542
Date: 5/15/23
Room: 104 LMCONS
Arrival Date: 5/14/23
Departure Date: 5/15/23
Check In Time: 5/14/23 2:19 PM
Check, Out Time: 5/15/23 11-06 AM
Rewards Program ID:
You were checked out by: jmacke
You were: checked in by., eveens
Total Balance Due: 0.00
we
0.00
Balance Due- 0,00
x
HOICE
privileges.
You could be earning free nights atChoice hotels and othergreat rewards. Join Choice
Privileges today by stopping by the front desk, or logging on to
www.choiceho.tels-comlchoice-pri.vile.ges.
Quality Inn (WA255)
449 Melva Lane
Quality-
Moses Lake, WA 98837
INN
(509) 765-8886
8Y CHOICE HOTELS
GM-WA255@choicehotels.com
NEW HOPE
HOPE, NEW
311 W 3RD
Moses Lake, WA 98837
With this rate you are able to earn valuable
Choice Privileges points!
Account: 869606542
Date: 5/15/23
Room: 104 LMCONS
Arrival Date: 5/14/23
Departure Date: 5/15/23
Check In Time: 5/14/23 2:19 PM
Check, Out Time: 5/15/23 11-06 AM
Rewards Program ID:
You were checked out by: jmacke
You were: checked in by., eveens
Total Balance Due: 0.00
we
0.00
Balance Due- 0,00
x
HOICE
privileges.
You could be earning free nights atChoice hotels and othergreat rewards. Join Choice
Privileges today by stopping by the front desk, or logging on to
www.choiceho.tels-comlchoice-pri.vile.ges.
Shelter/Hotel: Hotel
Date In:
Program:
DV
5114/2023
Client (First Initial & Last Name):
Year of Birth: 1985
Case ID.- 697123
Secondary #1 YOB: 2002
Secondary #2 YOB: 2005
Secondary #3 YOB:
Secondary #4 YOB:
Secondary #5 YOB:
Secondary #6 YOB:
0
Previous Living Situation?,
Where did client exit to?:
Payment Grant:
Comments:
Client Shelter Form
Hotel Name/Room in Shelter. Quality Inn/104
Date Out: 5/15/2023
Review Shelter Guidelines: Yes
0
Invoice Turned In.
Client ID: Z2Z31147
NCA Trak: 2023-283
Gender.- Male
Gender: Male
Gender:
Gender:
Gender:
Gender:
County of Grant
35 C ST NW
P.O. Box 37
Ephrata WA 98823
Vendor.- MELVA LANE LLC
DBA: QUAILITY INN
449 MELVA LANE
MOSES LAKE WA 98837
Document Number Purchase Order Number
F69-4'4'- -1, 647 --,--,M —H,
Description:
Emergency Shelter
Page I / 1
Invoice 0389173
Date 5/17/2023
VendorlD I Shipping Method
UALI I --------
I-,-,--. . . .............. .... . ... ..... . . .....
Subtotal
Misc
Tax
Freight
Trade Discount
Payment
Totat Due
Payment Terms ID
NET 30
Amount
$197.82
$197.82
$0.00
$0.00
$0.00
$0M00
Q$197.82
NEW HOPE
Quality Inn (WA 5)
449 Melva Lane
Quality
Moses Lake, WA 98837
INN
(509) 765-8886
By CHOICe *40'rELS
GM-WA255@choicehotels.com
NEW HOPE
HOPE, NEW
UNKNOWN
Moses Lake, WA 98837
Post Date
Descirl pAion
Comment
5/12/23
Room Charge
#110 HOPE, NEW
5/12/23
State Tax
5113/23
Room Charge
#110 HOPE, N . EW
5/1 /3
State Tax
5/14123
Room Charge
#110 HOPE, NEW
5114/23
State Tax
5/15/23
Direct Bill
Room Charge
State Tax
Direct Bill
Account: 869441647
Date: 5/15/23
Room: 110 WCONS
Arrival Date: 5/12/23
Departure Date: 5/15/23
Check In Time: 5112/23 11:01 PM
Check Out Time:
.Rewards Program ID:
You were checked out by:
You were checked in by: GPREBI
Total Balance Due: 0.00
Folio Summary 6/12/23 - 6/16/23
With this rate you are able to earn valuable
Choice Privileges points!
IV
S CHOICE
privileges.
Amount
60.00
5.94
60.00
5.94
60.00
5.9. 4
(197-82)
180,00
17.82
(197.82)
Balance Due: 0.00
(197.82) will be billed to: ' . AcQQurit 2277219
NEW HOPE, 604 West Third, Suite B, Moses Lake, WA 98837
You could be earning free nights at Choice hotels and other great rewards, Join Choice
Privileges today by stopping by the front desk, or logging on to
www.choicehotels-com/choice-privileges.
Shelter/Hotel:
Date In:
Program:
M
Hotel
5/14/2023
Client (first Initial & Last Name):
Year of Birth: 1985
Case ICS: 697123
Secondary #1 YOS: 2002
Secondary #2 YOB: 2005
Secondary #3 YOB:
Secondary #4 YOB*
Secondary #5 YOB:
Secondary #6 YOB:
Previous Living Situation?:
Where did client exit to?:
Payment Grant,
Comments:
Client Shelter Form
Hotel Name/Roomin Shelter Quality Inn/104
Date Out. 5/15/2023
.Review Shelter Guidelines: Yes
Invoice Turned In:
--------- -
Client ID: ZZZ3114
NCA Trak: 2023-283
Gender: Male
Gender: Male
Gender:
Gender:
0
Gender,
Gender:
County of Grant
35 C ST NW
P.O. Box 37
Ephrata. WA 98823
Vendor: MELVA LANE LLC
DBA: QUAILITY INN
449 MELVA LANE
MOSES LAKE WA 98837
Document Number Purchase Order Number VendorlD
8694346' 4 MH. - - -----
QUALI
—ip
Emergency Shelter
Page 1 / 1
Invoice 0389167
Date 5/17/2023
Shipping Method Payment Terms -ID --'---
NET 30
Amount
$197.82
Subtotal
$197.82
Mise
S0.00
Tax
$0.00
Frelight
$0.00
Trade Discount
$0.00
Payment
Total Due
$97.82
(:!N)
Q
Quality,
INN
BY CHOICE HOTELS
NEW HOPE
HOPE, NEW
UNKNOWN
Moses Lake, WA 98837
Quality Inn (WA255j
449 Melva Lane
Moses Lake, WA 98837
(509) 765-8886
GM.WA255@choicehotels.COM
Account: 869434694
kA
Date: 5/15/23
Room: 301 WCONS
Arrival Date: 5/12/23
Departure Date: 5/15/23
Check In Time: 5/12/23 9.*52 PM
Check Out Time:
Rewards Program ID:
You were checked out by:
You were checked in by: gprebi
Total Balance Due: 0.00
Post Date
Des criptiOn
Comment
Amount
5/12/23
Room Charge
#301 HOPE, NEW
60.00
5/12123
State Tax
5.94
5/13/23
Room Charge
#301 HOPE, NEW
60.00
5/13/23
State Tax,
5-94
5/14/23
Room Charge
-
#301 HOPE, NEW
60.00
5/14/23
State Tax
5.94
5/15/23
Direct Bill
(197.82)
Folio Summary 5/12/23 - 6/161.23
Room Charge
State Tax
Direct Bill
With this rate you are able to earn valuable
Choice Privileges points".
X
4P CHOICE
privileges.
REWAROS
180.00
17-82
(197.82)
Balance Due: 0.00
(197.82) will be billed to., Accoun't 2277219
NEW HOPE, 604 West Third, Suite 8 ,[doses Lake, WA 98837
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County of Grant
35 C ST NW
P.O. Box 37
Ephrata WA 98823
Vendor: MELvA LANE LLC
DBA, QUAILITY INN
449 ELVA LANE
MOSES LAKE WA 98837
Document Number Purchase Order'Number
869414013. MH
bescription:
Emergency Shelter
Page I /I
Invoice 0389174
Date 5/17/2023
endor Il .1 hlinMethod
Subtotal
Mise
Tax
Freight
Trade Discount
Payment
Total Due
Payment Terms ID
30
Amount
$263,76
$263.76
$0.00
$0,00
$0.00
$.0.00
00
Quality*
INN
BY CHOICE HOTELS
NEW HOPE
HOPE, NEW
UNKNOWN
Moses Lake,, WA, 98837
Post Date
5112/23
5112/23
5/13/23
5113123
5/14/23
5114/23
5/15/23
5/15/23
5/16/23
J�J\x
Description
Room Charge
State Tax
Room Charge
State Tax
Room Charge
State Tax
Room Charge
State Tax
Direct Bill
Room Charge
State Tax
Direct Bill
Quality Inn (WA255)
449 Melva Lane
Moses Lake, WA 98837
(509) 765-8886
GM-WA255@choicehotels.com
Comment
#201 HOPE, NEW
#201 HOPE, NEW
#201 HOPE, NEW
#201 HOPE, NEW
Account: 869414013
Date, 5/16/23
Room' 201 WCONS
Arrival Date: 5/12123
Departure Date:, 5/16/23
Check In Time: 5/12/23 11:14 PM
Check Out Time: 5/16123 11:03 AM
Rewards Program ID:
You were checked out by: CARRED,
You were checked in by, imacke
Total Balance Due: 0.00
Folio Summary 5/1,2/23 - 5116123
With this rate you are able to earn valuable
Choice Privileges points!
X
fl#CH� OICE
glees.
AFWA00%
Amount
60.00
5.94
60.00
5.94
60.00
5.94
60.00
5.94
(263.76)
240.00
23.76
(263.76)
Balance Due: 0.00
(263.76) will big billed to: Account 2277219
NEW HOPE, 604 West Third, Suite B, Moses Lake, WA 98837
You could be earning free nights at Choice hotels and other great rewards. Join Choice
Privileges today by stopping by the front desk, or logging on to
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Client Shelter Form
Shelter/Hate!: Shelter
Hotel Name/Room
in Shelter: Quality Inn
Date In: 5/12/2023 Date Out:
Program: DV
Review Shelter Guidelines: Yes
Invoice Turned In.
Client (First Initial & Last Name):
Year of Birth: 2004 Client ID: GML33090
Case ID:
696978 NCA Trak: 2023-277
Secondary #1 YOS:
Secondary #2 YOB:
Secondary #3 yOE;:
Secondary #4 YO8V
Secondary #5 YOB:
Secondary #6 YOB:
Previous Living Situation?, -
Where did client exit to?:
Payment Grant:
Gender:
Gender:
Gender:
Gender:
Gender:
Gender:
Staying or living w/friend
Comments: Client was staying in a hotel paid for by offender