| Payment ID | 18489 |
|---|---|
| Date Created | 02/27/23 12:20 pm |
| Created By | Gloria Jimenez |
| Service Request | 17828 |
| Application ID | 14769 |
| Authorization Number | |
| Applicant Information | |
| Name | Lisa Mims |
| Agency Name | ISD |
| Agency Code | 220501 |
| Agency | ISD |
| Agency Email Address | Email hidden; Javascript is required. |
| Applicant Email Address | Email hidden; Javascript is required. |
| Unique Identifier | 16171001123 |
| 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 | 02/21/2023 |
| To | 02/28/2023 |
| Days | 7 |
| Payment Details | |
| Payment Amount | $1,334.96 |
| Receipt Amount | $1,334.96 |
| Receipt Date | 02/23/2023 |
| Comments | hotel stay at Super 8 departure date is 02/28/23. payment made is for more than one service request |
| Receipt | 23-02-2023Mims1334.96.pdf |
| Staff Name | Gloria Jimenez |
| Case Manager | DJ |
| Case Worker Email | Email hidden; Javascript is required. |
| Verifier Name | Gloria Jimenez |
| Verifier Signature | |
| Date Verified | 02/27/2023 |
