| Payment ID | 119242 |
|---|---|
| Date Created | 08/28/25 3:27 pm |
| Created By | Gloria Jimenez |
| Service Request | 115192 |
| Application ID | 106942 |
| Authorization Number | 226730 |
| Applicant Information | |
| Name | Letitia Gongora |
| Applicant Email Address | Email hidden; Javascript is required. |
| Unique Identifier | 16170805088 |
| 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 | 2 |
| From | 07/16/2025 |
| To | 07/23/2025 |
| Days | 7 |
| Payment Details | |
| Payment Amount | $501.00 |
| Receipt Amount | $2,428.62 |
| Receipt Date | 08/26/2025 |
| Comments | hotel stay at Super 8 this payment includes more than one service request |
| Receipt | |
| Staff Name | Gloria Jimenez |
| Case Manager | DL |
| Case Worker Email | Email hidden; Javascript is required. |
| Verifier Name | Gloria Jimenez |
| Verifier Signature | |
| Date Verified | 08/28/2025 |
