| Payment ID | 26138 |
|---|---|
| Date Created | 05/17/23 10:25 am |
| Created By | Gloria Jimenez |
| Service Request | 26027 |
| Application ID | 3802 |
| Authorization Number | |
| Applicant Information | |
| Name | Laura Coulson |
| Applicant Email Address | Email hidden; Javascript is required. |
| Unique Identifier | 16170600363 |
| Payment Type | Short-Term Hotel/Motel Stays |
| Type of Service Request | Hotel Stay |
| Location | Extended Stay |
| Location Contact Name | Vanya |
| Location Email Address | Email hidden; Javascript is required. |
| Start Day | Monday |
| Guests | 3 |
| From | 05/17/2023 |
| To | 05/24/2023 |
| Days | 8 |
| Payment Details | |
| Payment Amount | $500.00 |
| Receipt Amount | $1,371.76 |
| Receipt Date | 05/16/2023 |
| Comments | payment to Extended stay this payment includes more than one service request 25225. departure date is 05/24/23 |
| Receipt | 26138-Coulson.pdf |
| Staff Name | Gloria Jimenez |
| Case Manager | DL |
| Case Worker Email | Email hidden; Javascript is required. |
| Verifier Name | Gloria Jimenez |
| Verifier Signature | |
| Date Verified | 05/17/2023 |
Housing Stability Services Program
Available 24/7
Housing Stability Services Program
Available 24/7
Funded by Texas Department of Housing and Community Affairs
Funded by Texas Department of Housing and Community Affairs