| Payment ID | 112455 |
|---|---|
| Date Created | 06/23/25 2:19 pm |
| Created By | Gloria Jimenez |
| Service Request | 111146 |
| Application ID | 100773 |
| Authorization Number | 226382 |
| Applicant Information | |
| Name | Michal Lang |
| Applicant Email Address | Email hidden; Javascript is required. |
| Unique Identifier | 07466104847 |
| 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 | 06/18/2025 |
| To | 06/25/2025 |
| Days | 7 |
| Payment Details | |
| Payment Amount | $550.00 |
| Receipt Amount | $529.48 |
| Receipt Date | 06/20/2025 |
| Comments | hotel paid at Motel 6 departure date is 06/25/25 |
| 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 |
