| Payment ID | 106354 |
|---|---|
| Date Created | 05/19/25 9:24 am |
| Created By | Gloria Jimenez |
| Service Request | 101286 |
| Application ID | 43397 |
| Authorization Number | 225707 |
| Applicant Information | |
| Name | Kyaneisha Miles |
| Applicant Email Address | Email hidden; Javascript is required. |
| Unique Identifier | 16166402531 |
| 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 | 5 |
| From | 04/16/2025 |
| To | 04/23/2025 |
| Days | 7 |
| Payment Details | |
| Payment Amount | $500.01 |
| Receipt Amount | $774.41 |
| Receipt Date | 05/16/2025 |
| Comments | Hotel stay at Super 8 |
| Receipt | |
| Staff Name | Gloria Jimenez |
| Case Manager | SJ |
| Case Worker Email | Email hidden; Javascript is required. |
| Verifier Name | Gloria Jimenez |
| Verifier Signature | |
| Date Verified | 05/19/2025 |
