| Payment ID | 54256 |
|---|---|
| Date Created | 01/29/24 11:38 am |
| Created By | Gloria Jimenez |
| Service Request | 53754 |
| Application ID | 44451 |
| Authorization Number | 223289 |
| Applicant Information | |
| Name | Jennie Sharp |
| Applicant Email Address | Email hidden; Javascript is required. |
| Unique Identifier | 16171102591 |
| Payment Type | Short-Term Hotel/Motel Stays |
| Type of Service Request | Hotel Stay |
| Location | Delta Inn |
| Location Contact Name | Crystal |
| Location Email Address | Email hidden; Javascript is required. |
| Start Day | Thursday |
| Guests | 2 |
| From | 01/25/2024 |
| To | 01/31/2024 |
| Days | 6 |
| Payment Details | |
| Payment Amount | $400.00 |
| Receipt Amount | $345.00 |
| Receipt Date | 01/25/2024 |
| Comments | hotel stay at Delta Inn, departure date is 02/01/24 |
| Receipt | 54256-Sharp.pdf |
| Staff Name | Gloria |
| Case Manager | BP |
| Case Worker Email | Email hidden; Javascript is required. |
| Verifier Name | Gloria Jimenez |
| Verifier Signature | |
| Date Verified | 01/29/2024 |
