| Payment ID | 101691 |
|---|---|
| Date Created | 04/16/25 2:52 pm |
| Created By | Gloria Jimenez |
| Service Request | 100408 |
| Application ID | 19853 |
| Authorization Number | 225635 |
| Applicant Information | |
| Name | Mi'Eisha Walker |
| Applicant Email Address | Email hidden; Javascript is required. |
| Unique Identifier | 16170601398 |
| Payment Type | Short-Term Hotel/Motel Stays |
| Type of Service Request | Hotel Stay |
| Location | Super 8 Waco University Area |
| Location Contact Name | Crystal |
| Location Email Address | Email hidden; Javascript is required. |
| Start Day | Monday |
| Guests | 3 |
| From | 04/09/2025 |
| To | 04/16/2025 |
| Days | 7 |
| Payment Details | |
| Payment Amount | $500.00 |
| Receipt Amount | $2,000.04 |
| Receipt Date | 04/10/2025 |
| Comments | hotel stay at Super 8 departure date is 04/16/25, this payment includes more than one service request |
| Receipt | |
| Staff Name | Gloria Jimenez |
| Case Manager | LRE |
| Case Worker Email | Email hidden; Javascript is required. |
| Verifier Name | Gloria Jimenez |
| Verifier Signature | |
| Date Verified | 04/16/2025 |
