| Payment ID | 61481 |
|---|---|
| Date Created | 03/12/24 1:10 pm |
| Created By | Gloria Jimenez |
| Service Request | 60728 |
| Application ID | 53011 |
| Authorization Number | 223630 |
| Applicant Information | |
| Name | Kingsley Eskew |
| Applicant Email Address | Email hidden; Javascript is required. |
| Unique Identifier | 16170502861 |
| 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 | Monday |
| Guests | 1 |
| From | 03/06/2024 |
| To | 03/13/2024 |
| Days | 7 |
| Payment Details | |
| Payment Amount | $800.00 |
| Receipt Amount | $98.88 |
| Receipt Date | 03/07/2024 |
| Comments | hotel stay at Delta Inn |
| Receipt | 61481-Eskew.pdf |
| Staff Name | Gloria |
| Case Manager | BJ |
| Case Worker Email | Email hidden; Javascript is required. |
| Verifier Name | Gloria Jimenez |
| Verifier Signature | |
| Date Verified | 03/12/2024 |
