| Payment ID | 98887 |
|---|---|
| Date Created | 03/25/25 3:15 pm |
| Created By | Gloria Jimenez |
| Service Request | 97579 |
| Application ID | 95846 |
| Authorization Number | 225425 |
| Applicant Information | |
| Name | Laquittia Williams |
| Applicant Email Address | Email hidden; Javascript is required. |
| Unique Identifier | 16170504630 |
| Payment Type | Short-Term Hotel/Motel Stays |
| Type of Service Request | Hotel Stay |
| Location | Delta Inn |
| Start Day | Monday |
| Guests | 3 |
| From | 03/17/2025 |
| To | 03/26/2025 |
| Days | 9 |
| Payment Details | |
| Payment Amount | $400.00 |
| Receipt Amount | $332.35 |
| Receipt Date | 03/19/2025 |
| Comments | hotel stay at Delta Inn |
| Receipt | |
| Staff Name | Gloria Jimenez |
| Case Manager | DL |
| Case Worker Email | Email hidden; Javascript is required. |
| Verifier Name | Gloria Jimenez |
| Verifier Signature | |
| Date Verified | 03/25/2025 |
