| Payment ID | 112469 |
|---|---|
| Date Created | 06/23/25 2:35 pm |
| Created By | Gloria Jimenez |
| Service Request | 109978 |
| Application ID | 92988 |
| Authorization Number | 226274 |
| Applicant Information | |
| Name | James Graham |
| Applicant Email Address | Email hidden; Javascript is required. |
| Unique Identifier | 16170504510 |
| 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 | 5 |
| From | 06/11/2025 |
| To | 06/18/2025 |
| Days | 7 |
| Payment Details | |
| Payment Amount | $500.00 |
| Receipt Amount | $1,330.92 |
| Receipt Date | 06/16/2025 |
| Comments | payment made to Motel 6 departing 06/18/25 |
| Receipt | |
| Staff Name | Gloria Jimenez |
| Case Manager | LRE |
| Case Worker Email | Email hidden; Javascript is required. |
| Verifier Name | Gloria Jimenez |
| Verifier Signature | |
| Date Verified | 06/23/2025 |
