| Payment ID | 106430 |
|---|---|
| Date Created | 05/19/25 11:56 am |
| Created By | Gloria Jimenez |
| Service Request | 105834 |
| Application ID | 100773 |
| Authorization Number | 225918 |
| Applicant Information | |
| Name | Michal Lang |
| Applicant Email Address | Email hidden; Javascript is required. |
| Unique Identifier | 07466104847 |
| 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 | 05/15/2025 |
| To | 05/21/2025 |
| Days | 6 |
| Payment Details | |
| Payment Amount | $500.00 |
| Receipt Amount | $441.54 |
| Receipt Date | 05/16/2025 |
| Comments | hotel stay at Motlel 6 |
| Receipt | |
| Staff Name | Gloria Jimenez |
| Case Manager | BP |
| Case Worker Email | Email hidden; Javascript is required. |
| Verifier Name | Gloria Jimenez |
| Verifier Signature | |
| Date Verified | 05/19/2025 |
