| Payment ID | 19945 |
|---|---|
| Date Created | 03/16/23 11:04 am |
| Created By | Gloria Jimenez |
| Service Request | 17041 |
| Application ID | 16434 |
| Authorization Number | |
| Applicant Information | |
| Name | Lucy Olivarez |
| Applicant Email Address | Email hidden; Javascript is required. |
| Unique Identifier | 16101231 |
| Payment Type | Short-Term Hotel/Motel Stays |
| Type of Service Request | Hotel Stay |
| Location | Other |
| Name of Location | Super 8 Waco |
| Start Day | Thursday |
| Guests | 2 |
| From | 02/09/2023 |
| To | 02/16/2023 |
| Days | 7 |
| Payment Details | |
| Payment Amount | $1,068.00 |
| Receipt Amount | $1,068.00 |
| Receipt Date | 03/13/2023 |
| Comments | hotel stay at Super 8 departure date is 03/13/23 |
| Receipt | 13-03-2023Olivarez1068.00.pdf |
| Staff Name | Gloria Jimenez |
| Staff Signature | |
| Case Manager | DL |
| Case Worker Email | Email hidden; Javascript is required. |
| Verifier Name | Gloria Jimenez |
| Verifier Signature | |
| Date Verified | 03/16/2023 |
