| Payment ID | 23347 |
|---|---|
| Date Created | 04/20/23 10:57 am |
| Created By | Gloria Jimenez |
| Service Request | 21544 |
| 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 | Super 8 Waco University Area |
| Location Contact Name | Crystal |
| Location Email Address | Email hidden; Javascript is required. |
| Start Day | Monday |
| Guests | 1 |
| From | 04/07/2023 |
| To | 04/14/2023 |
| Days | 7 |
| Payment Details | |
| Payment Amount | $623.00 |
| Receipt Amount | $1,513.12 |
| Receipt Date | 04/19/2023 |
| Comments | hotel stay at Super 8 departure date is 04/19/23. |
| Receipt | 19-04-2023Robinson1513.12.pdf |
| Staff Name | Gloria Jimenez |
| Case Manager | DJ |
| Case Worker Email | Email hidden; Javascript is required. |
| Verifier Name | Gloria Jimenez |
| Verifier Signature | |
| Date Verified | 04/20/2023 |
