| Payment ID | 114959 |
|---|---|
| Date Created | 07/14/25 11:24 am |
| Created By | Gloria Jimenez |
| Service Request | 112390 |
| Application ID | 92988 |
| Authorization Number | 226475 |
| 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 | 07/01/2025 |
| To | 07/02/2025 |
| Days | 1 |
| Payment Details | |
| Payment Amount | $100.00 |
| Receipt Amount | $517.61 |
| Receipt Date | 07/11/2025 |
| Comments | hotel stay at Motel 6 departure date is 07/17/25 |
| Receipt | |
| Staff Name | Gloria Jimenez |
| Case Manager | LRE |
| Case Worker Email | Email hidden; Javascript is required. |
| Verifier Name | Gloria Jimenez |
| Verifier Signature | |
| Date Verified | 07/14/2025 |
