| Payment ID | 107015 |
|---|---|
| Date Created | 05/21/25 10:55 am |
| Created By | Gloria Jimenez |
| Service Request | 101001 |
| Application ID | 99648 |
| Authorization Number | |
| Applicant Information | |
| Name | Warren O'Loughlin |
| Applicant Email Address | Email hidden; Javascript is required. |
| Unique Identifier | 16170704799 |
| 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 | 1 |
| From | 04/14/2025 |
| To | 04/23/2025 |
| Days | 9 |
| Payment Details | |
| Payment Amount | $600.00 |
| Receipt Amount | $642.87 |
| Receipt Date | 05/20/2025 |
| Comments | hotel stay at Super 8 departure date is 05/23/25 |
| Receipt | |
| Staff Name | Gloria Jimenez |
| Case Manager | LRE |
| Case Worker Email | Email hidden; Javascript is required. |
| Verifier Name | Gloria Jimenez |
| Verifier Signature | |
| Date Verified | 05/21/2025 |
