| Payment ID | 94037 |
|---|---|
| Date Created | 02/19/25 11:48 am |
| Created By | Gloria Jimenez |
| Service Request | 92470 |
| Application ID | 90048 |
| Authorization Number | 225030 |
| Applicant Information | |
| Name | Loletta Easley |
| Applicant Email Address | Email hidden; Javascript is required. |
| Unique Identifier | 16170504401 |
| Payment Type | Short-Term Hotel/Motel Stays |
| Type of Service Request | Hotel Stay |
| Location | Delta Inn |
| Start Day | Monday |
| Guests | 2 |
| From | 02/12/2025 |
| To | 02/19/2025 |
| Days | 7 |
| Payment Details | |
| Payment Amount | $500.00 |
| Receipt Amount | $664.70 |
| Receipt Date | 02/13/2025 |
| Comments | hotel stay at Delta Inn departure date is 02/19/25 |
| Receipt | |
| Staff Name | Gloria Jimenez |
| Case Manager | SJ |
| Case Worker Email | Email hidden; Javascript is required. |
| Verifier Name | Gloria Jimenez |
| Verifier Signature | |
| Date Verified | 02/19/2025 |
