| Payment ID | 23911 |
|---|---|
| Date Created | 04/25/23 10:13 am |
| Created By | Gloria Jimenez |
| Service Request | 23215 |
| Application ID | 5619 |
| Authorization Number | |
| Applicant Information | |
| Name | Laikeda Taylor |
| Applicant Email Address | Email hidden; Javascript is required. |
| Unique Identifier | 16170600516 |
| 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 | 3 |
| From | 04/19/2023 |
| To | 05/03/2023 |
| Days | 14 |
| Payment Details | |
| Payment Amount | $1,400.00 |
| Receipt Amount | $1,246.00 |
| Receipt Date | 04/20/2023 |
| Comments | hotel stay at Super 8 arrival 04/19/23 departure date is 05/03/2023 |
| Receipt | 20-04-2023Taylor1246.00.pdf |
| Staff Name | Gloria Jimenez |
| Case Manager | LRE |
| Case Worker Email | Email hidden; Javascript is required. |
| Verifier Name | Gloria Jimenez |
| Verifier Signature | |
| Date Verified | 04/25/2023 |
