| Payment ID | 112369 |
|---|---|
| Date Created | 06/23/25 11:45 am |
| Created By | Gloria Jimenez |
| Service Request | 111903 |
| Application ID | 103223 |
| Authorization Number | 226434 |
| Applicant Information | |
| Name | Ginger Pittman |
| Applicant Email Address | Email hidden; Javascript is required. |
| Unique Identifier | 16171504903 |
| 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 | 06/19/2025 |
| To | 06/23/2025 |
| Days | 4 |
| Payment Details | |
| Payment Amount | $286.86 |
| Receipt Amount | $369.70 |
| Receipt Date | 06/20/2025 |
| Comments | payment made to 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 | 06/23/2025 |
