| Payment ID | 19233 |
|---|---|
| Date Created | 03/07/23 1:28 pm |
| Created By | Gloria Jimenez |
| Service Request | 17485 |
| Application ID | 5781 |
| Authorization Number | |
| Applicant Information | |
| Name | Veronica Hernandez |
| Applicant Email Address | Email hidden; Javascript is required. |
| Unique Identifier | 16170800537 |
| Payment Type | Short-Term Hotel/Motel Stays |
| Type of Service Request | Hotel Stay |
| Location | Other |
| Name of Location | SUPER 8 WACO |
| Start Day | Monday |
| Guests | 1 |
| From | 02/13/2023 |
| To | 02/20/2023 |
| Days | 7 |
| Payment Details | |
| Payment Amount | $623.00 |
| Receipt Amount | $623.00 |
| Receipt Date | 03/01/2023 |
| Comments | hotel stay at Super 8 |
| Receipt | 01-03-2023Hernandez623.00.pdf |
| Staff Name | Gloria Jimenez |
| Case Manager | DG |
| Case Worker Email | Email hidden; Javascript is required. |
| Verifier Name | Gloria Jimenez |
| Verifier Signature | |
| Date Verified | 03/07/2023 |
