| Payment ID | 103167 |
|---|---|
| Date Created | 04/17/25 1:28 pm |
| Created By | Gloria Jimenez |
| Service Request | 100580 |
| Application ID | 96127 |
| Authorization Number | 225658 |
| Applicant Information | |
| Name | Desiree Wilkerson |
| Applicant Email Address | Email hidden; Javascript is required. |
| Unique Identifier | 16171004643 |
| Payment Type | Short-Term Hotel/Motel Stays |
| Type of Service Request | Hotel Stay |
| Location | Motel 6 Waco |
| Location Contact Name | Laurel |
| Location Email Address | Email hidden; Javascript is required. |
| Start Day | Monday |
| Guests | 2 |
| From | 04/08/2025 |
| To | 04/16/2025 |
| Days | 8 |
| Payment Details | |
| Payment Amount | $600.00 |
| Receipt Amount | $591.52 |
| Receipt Date | 04/14/2025 |
| Comments | hotel stay at Motel 6 departing the 16th of April, this 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 | 04/17/2025 |
