| Payment ID | 24176 |
|---|---|
| Date Created | 04/26/23 12:05 pm |
| Created By | Gloria Jimenez |
| Service Request | 23666 |
| Application ID | 13632 |
| Authorization Number | |
| Applicant Information | |
| Name | Quntabia Webb |
| Applicant Email Address | Email hidden; Javascript is required. |
| Unique Identifier | 16170701047 |
| 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 | 4 |
| From | 04/28/2023 |
| To | 05/05/2023 |
| Days | 7 |
| Payment Details | |
| Payment Amount | $700.00 |
| Receipt Amount | $562.48 |
| Receipt Date | 04/25/2023 |
| Comments | hotel stay at Super 8 departure date is 05/03/23 |
| Receipt | 25-04-2023Webb562.48.pdf |
| Staff Name | Gloria Jimenez |
| Case Manager | LRE |
| Case Worker Email | Email hidden; Javascript is required. |
| Verifier Name | Gloria Jimenez |
| Verifier Signature | |
| Date Verified | 04/26/2023 |
