| Payment ID | 112353 |
|---|---|
| Date Created | 06/23/25 10:54 am |
| Created By | Gloria Jimenez |
| Service Request | 112235 |
| Application ID | 100850 |
| Authorization Number | 226449 |
| Applicant Information | |
| Name | Brian Doston |
| Applicant Email Address | Email hidden; Javascript is required. |
| Unique Identifier | 16170504852 |
| 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 | 2 |
| From | 06/25/2025 |
| To | 07/01/2025 |
| Days | 6 |
| Payment Details | |
| Payment Amount | $428.58 |
| Receipt Amount | $972.31 |
| Receipt Date | 06/20/2025 |
| Comments | payment made to Motel 6 departure date is 07/01/2025 |
| Receipt | |
| Staff Name | Gloria Jimenez |
| Case Manager | SJ |
| Case Worker Email | Email hidden; Javascript is required. |
| Verifier Name | Gloria Jimenez |
| Verifier Signature | |
| Date Verified | 06/23/2025 |
