| Payment ID | 27045 |
|---|---|
| Date Created | 05/25/23 3:24 pm |
| Created By | Gloria Jimenez |
| Service Request | 22195 |
| Application ID | 6226 |
| Authorization Number | |
| Applicant Information | |
| Name | Sadrina Gardner |
| Applicant Email Address | Email hidden; Javascript is required. |
| Unique Identifier | 16170400557 |
| 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 | 4 |
| From | 04/12/2023 |
| To | 04/19/2023 |
| Days | 7 |
| Payment Details | |
| Payment Amount | $700.00 |
| Receipt Amount | $1,057.01 |
| Receipt Date | 05/18/2023 |
| Comments | hotel stay at Super 8, a charge for stay in April that was not charged until May receipts covers more than one service request |
| Receipt | 27045-Gardner.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 |
