| Payment ID | 111318 |
|---|---|
| Date Created | 06/17/25 2:44 pm |
| Created By | Gloria Jimenez |
| Service Request | 111132 |
| Application ID | 109341 |
| Authorization Number | 226387 |
| Applicant Information | |
| Name | Rick Sunday |
| Applicant Email Address | Email hidden; Javascript is required. |
| Unique Identifier | 16165705157 |
| 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 | 06/17/2025 |
| To | 06/25/2025 |
| Days | 8 |
| Payment Details | |
| Payment Amount | $573.71 |
| Receipt Amount | $664.70 |
| Receipt Date | 06/16/2025 |
| Comments | hotel stay at Delta Inn departure date is 06/23/25 |
| Receipt | |
| Staff Name | Gloria Jimenez |
| Case Manager | DJ |
| Case Worker Email | Email hidden; Javascript is required. |
| Verifier Name | Gloria Jimenez |
| Verifier Signature | |
| Date Verified | 06/17/2025 |
