| Payment ID | 23415 |
|---|---|
| Date Created | 04/20/23 2:04 pm |
| Created By | Gloria Jimenez |
| Service Request | 22824 |
| Application ID | 17405 |
| Authorization Number | |
| Applicant Information | |
| Name | Chanelle Carr |
| Applicant Email Address | Email hidden; Javascript is required. |
| Unique Identifier | 16170601288 |
| 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 | Thursday |
| Guests | 1 |
| From | 04/21/2023 |
| To | 04/28/2023 |
| Days | 7 |
| Payment Details | |
| Payment Amount | $700.00 |
| Receipt Amount | $1,780.00 |
| Receipt Date | 04/18/2023 |
| Comments | hotel stay at Super 8 departure date 04/26/23. amount included more than one service request, 22276, 21494 |
| Receipt | 18-04-2023Carr1780.00.pdf |
| Staff Name | Gloria Jimenez |
| Case Manager | LRE |
| Case Worker Email | Email hidden; Javascript is required. |
| Verifier Name | Gloria Jimenez |
| Verifier Signature | |
| Date Verified | 04/20/2023 |
