| Payment ID | 23909 |
|---|---|
| Date Created | 04/25/23 10:08 am |
| Created By | Gloria Jimenez |
| Service Request | 22444 |
| Application ID | 19392 |
| Authorization Number | |
| Applicant Information | |
| Name | Kimberly Thomas |
| Applicant Email Address | Email hidden; Javascript is required. |
| Unique Identifier | 16171001374 |
| 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 | 04/13/2023 |
| To | 04/20/2023 |
| Days | 7 |
| Payment Details | |
| Payment Amount | $623.00 |
| Receipt Amount | $2,403.00 |
| Receipt Date | 04/20/2023 |
| Comments | hotel stay at Super 8 arrival 03/30/23 departure 04/26/23. this payment includes service request 21887, 21130, 23204 |
| Receipt | 20-04-2023Thomas2403.00.pdf |
| Staff Name | Gloria Jimenez |
| Case Manager | DG |
| Case Worker Email | Email hidden; Javascript is required. |
| Verifier Name | Gloria Jimenez |
| Verifier Signature | |
| Date Verified | 04/25/2023 |
