| Payment ID | 104500 |
|---|---|
| Date Created | 05/01/25 4:56 pm |
| Created By | Gloria Jimenez |
| Service Request | 103416 |
| Application ID | 99540 |
| Authorization Number | 225774 |
| Applicant Information | |
| Name | Thomas Davis |
| Agency Name | Veterans Administration |
| Agency Code | 220308 |
| Agency | Veterans Administration |
| Agency Email Address | Email hidden; Javascript is required. |
| Applicant Email Address | Email hidden; Javascript is required. |
| Unique Identifier | 16170604795 |
| 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 | 1 |
| From | 04/23/2025 |
| To | 04/30/2025 |
| Days | 7 |
| Payment Details | |
| Payment Amount | $502.00 |
| Receipt Amount | $1,060.16 |
| Receipt Date | 04/30/2025 |
| Comments | hotel stay at Motel stay this payment includes more than one service request |
| Receipt | |
| Staff Name | Gloria Jimenez |
| Case Manager | DJ |
| Case Worker Email | Email hidden; Javascript is required. |
| Verifier Name | Gloria Jimenez |
| Verifier Signature | |
| Date Verified | 05/01/2025 |
