| Payment ID | 118772 |
|---|---|
| Date Created | 08/21/25 2:37 pm |
| Created By | Gloria Jimenez |
| Service Request | 117495 |
| Application ID | 110692 |
| Authorization Number | 226865 |
| Applicant Information | |
| Name | Mark Blanco |
| Applicant Email Address | Email hidden; Javascript is required. |
| Unique Identifier | 16168205230 |
| Payment Type | Short-Term Hotel/Motel Stays |
| Type of Service Request | Hotel Stay |
| Location | Super 8 Waco University Area |
| Location Contact Name | Crystal |
| Location Email Address | Email hidden; Javascript is required. |
| Start Day | Monday |
| Guests | 1 |
| From | 08/06/2025 |
| To | 08/13/2025 |
| Days | 7 |
| Payment Details | |
| Payment Amount | $500.00 |
| Receipt Amount | $1,700.03 |
| Receipt Date | 08/19/2025 |
| Comments | hotel stay at Super 8 |
| Receipt | |
| Staff Name | Gloria Jimenez |
| Case Manager | LRE |
| Case Worker Email | Email hidden; Javascript is required. |
| Verifier Name | Gloria Jimenez |
| Verifier Signature | |
| Date Verified | 08/21/2025 |
