| Payment ID | 61490 |
|---|---|
| Date Created | 03/12/24 1:22 pm |
| Created By | Gloria Jimenez |
| Service Request | 60226 |
| Application ID | 52151 |
| Authorization Number | 223610 |
| Applicant Information | |
| Name | Crystal Humbert |
| Applicant Email Address | Email hidden; Javascript is required. |
| Unique Identifier | 16170502839 |
| 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 | 2 |
| From | 03/06/2024 |
| To | 03/13/2024 |
| Days | 7 |
| Payment Details | |
| Payment Amount | $600.00 |
| Receipt Amount | $1,311.00 |
| Receipt Date | 03/07/2024 |
| Comments | hotel stay at Delta Inn departure date is 03/16/24, this payment includes more than one service request |
| Receipt | 61490-Humbert.pdf |
| Staff Name | Gloria |
| Case Manager | LRE |
| Case Worker Email | Email hidden; Javascript is required. |
| Verifier Name | Gloria Jimenez |
| Verifier Signature | |
| Date Verified | 03/12/2024 |
