| Payment ID | 26977 |
|---|---|
| Date Created | 05/25/23 10:22 am |
| Created By | Gloria Jimenez |
| Service Request | 26467 |
| Application ID | 25245 |
| Authorization Number | |
| Applicant Information | |
| Name | Kristy Martin |
| Applicant Email Address | Email hidden; Javascript is required. |
| Unique Identifier | 16166401637 |
| 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 | Monday |
| Guests | 1 |
| From | 05/24/2023 |
| To | 05/31/2023 |
| Days | 7 |
| Payment Details | |
| Payment Amount | $585.00 |
| Receipt Amount | $1,096.95 |
| Receipt Date | 05/24/2023 |
| Comments | hotel stay at Motel 6 departure date is 06/01/23. This amount includes payment for more than one receipt |
| Receipt | 26977-Martin.pdf |
| Staff Name | Gloria Jimenez |
| Case Manager | DG |
| Case Worker Email | Email hidden; Javascript is required. |
| Verifier Name | Gloria Jimenez |
| Verifier Signature | |
| Date Verified | 05/25/2023 |
