| Payment ID | 110808 |
|---|---|
| Date Created | 06/16/25 12:08 pm |
| Created By | Gloria Jimenez |
| Service Request | 109067 |
| Application ID | 90467 |
| Authorization Number | 226191 |
| Applicant Information | |
| Name | Carlos Rodriguez |
| 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 | 16171104409 |
| Payment Type | Short-Term Hotel/Motel Stays |
| Type of Service Request | Hotel Stay |
| Location | Delta Inn |
| Start Day | Monday |
| Guests | 1 |
| From | 06/04/2025 |
| To | 06/11/2025 |
| Days | 7 |
| Payment Details | |
| Payment Amount | $450.00 |
| Receipt Amount | $664.71 |
| Receipt Date | 06/16/2025 |
| Comments | hotel paid at Delta Inn departure date is 06/15/25 |
| Receipt | |
| Staff Name | Gloria Jimenez |
| Case Manager | DJ |
| Case Worker Email | Email hidden; Javascript is required. |
| Verifier Name | Gloria Jimenez |
| Verifier Signature | |
| Date Verified | 06/16/2025 |
Housing Stability Services Program
Available 24/7
Housing Stability Services Program
Available 24/7
Funded by Texas Department of Housing and Community Affairs
Funded by Texas Department of Housing and Community Affairs