| Payment ID | 21387 |
|---|---|
| Date Created | 03/31/23 3:21 pm |
| Created By | Rick Jaimes |
| Service Request | 20842 |
| Application ID | 9366 |
| Authorization Number | |
| Applicant Information | |
| Name | Alton Robinson |
| Agency Name | Veterans Administration |
| Agency Code | 220308 |
| Agency | Veterans Administration |
| Agency Email Address | Email hidden; Javascript is required. |
| Applicant Email Address | Email hidden; Javascript is required. |
| Unique Identifier | 16170400764 |
| Payment Type | Short-Term Hotel/Motel Stays |
| Type of Service Request | Hotel Stay |
| Location | Other |
| Name of Location | Super 8 Baylor |
| Start Day | Monday |
| Guests | 1 |
| From | 03/29/2023 |
| To | 04/07/2023 |
| Days | 7 |
| Payment Details | |
| Payment Amount | $801.00 |
| Receipt Amount | $801.00 |
| Receipt Date | 03/30/2023 |
| Comments | Hotel Stay at Super 8 Departure date:4/7/23 |
| Receipt | 30-03-2023Robinson801.00.pdf |
| Staff Name | Rick Jaimes |
| Case Manager | DJ |
| Case Worker Email | Email hidden; Javascript is required. |
| Verifier Name | Rick Jaimes |
| Verifier Signature | |
| Date Verified | 03/31/2023 |
