| Payment ID | 19723 |
|---|---|
| Date Created | 03/14/23 1:01 pm |
| Created By | Gloria Jimenez |
| Service Request | 17399 |
| Application ID | 15808 |
| Authorization Number | |
| Applicant Information | |
| Name | Adrian Smith |
| Applicant Email Address | Email hidden; Javascript is required. |
| Unique Identifier | 16170601197 |
| Payment Type | Short-Term Hotel/Motel Stays |
| Type of Service Request | Hotel Stay |
| Location | Delta Inn |
| Location Contact Name | Crystal |
| Location Email Address | Email hidden; Javascript is required. |
| Start Day | Monday |
| Guests | 1 |
| From | 02/14/2023 |
| To | 02/21/2023 |
| Days | 7 |
| Payment Details | |
| Payment Amount | $422.05 |
| Receipt Amount | $422.05 |
| Receipt Date | 03/13/2023 |
| Comments | hotel stay at Delta Inn |
| Receipt | 13-03-2023Smith422.05.pdf |
| Staff Name | Gloria Jimenez |
| Case Manager | DL |
| Case Worker Email | Email hidden; Javascript is required. |
| Verifier Name | Gloria Jimenez |
| Verifier Signature | |
| Date Verified | 03/14/2023 |
Housing Stability Services Program
Available 24/7
Housing Stability Services Program
Available 24/7
Funded by Texas Department of Housing and Community Affairs
Funded by Texas Department of Housing and Community Affairs