| Payment ID | 112383 |
|---|---|
| Date Created | 06/23/25 12:01 pm |
| Created By | Gloria Jimenez |
| Service Request | 110597 |
| Application ID | 108150 |
| Authorization Number | 226352 |
| Applicant Information | |
| Name | Jimmy Dunson |
| Applicant Email Address | Email hidden; Javascript is required. |
| Unique Identifier | 16170105119 |
| 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 | 06/16/2025 |
| To | 07/01/2025 |
| Days | 9 |
| Payment Details | |
| Payment Amount | $650.00 |
| Receipt Amount | $1,109.10 |
| Receipt Date | 06/20/2025 |
| Comments | hotel paid through 07/01/2025, extended service request to reflect payment |
| Receipt | |
| Staff Name | Gloria Jimenez |
| Case Manager | BP |
| Case Worker Email | Email hidden; Javascript is required. |
| Verifier Name | Gloria Jimenez |
| Verifier Signature | |
| Date Verified | 06/23/2025 |
