| Payment ID | 26974 |
|---|---|
| Date Created | 05/25/23 10:10 am |
| Created By | Gloria Jimenez |
| Service Request | 26376 |
| 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 | Motel 6 Waco |
| Location Contact Name | Laurel |
| Location Email Address | Email hidden; Javascript is required. |
| Start Day | Thursday |
| Guests | 4 |
| From | 05/19/2023 |
| To | 05/24/2023 |
| Days | 5 |
| Payment Details | |
| Payment Amount | $600.00 |
| Receipt Amount | $398.25 |
| Receipt Date | 05/24/2023 |
| Comments | hotel stay at Motel 6 departure date is 05/24/23 |
| Receipt | 26974-Webb.pdf |
| Staff Name | Gloria Jimenez |
| Case Manager | LRE |
| Case Worker Email | Email hidden; Javascript is required. |
| Verifier Name | Gloria Jimenez |
| Verifier Signature | |
| Date Verified | 05/25/2023 |
