| Payment ID | 119191 |
|---|---|
| Date Created | 08/28/25 11:25 am |
| Created By | Gloria Jimenez |
| Service Request | 117555 |
| Application ID | 87036 |
| Authorization Number | 226881 |
| Applicant Information | |
| Name | Mendy Ruiz |
| Applicant Email Address | Email hidden; Javascript is required. |
| Unique Identifier | 16170504240 |
| 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 | 3 |
| From | 08/06/2025 |
| To | 08/13/2025 |
| Days | 7 |
| Payment Details | |
| Payment Amount | $500.00 |
| Receipt Amount | $1,787.03 |
| Receipt Date | 08/27/2025 |
| Comments | HOTEL STAY AT SUPER 8 DEPARTURE DATE IS 08/14/25 |
| Receipt | |
| Staff Name | Gloria Jimenez |
| Case Manager | LRE |
| Case Worker Email | Email hidden; Javascript is required. |
| Verifier Name | Gloria Jimenez |
| Verifier Signature | |
| Date Verified | 08/28/2025 |
