| Payment ID | 27236 |
|---|---|
| Date Created | 05/30/23 11:34 am |
| Created By | Gloria Jimenez |
| Service Request | 26958 |
| Application ID | 4197 |
| Authorization Number | |
| Applicant Information | |
| Name | Celia Samaniego |
| Applicant Email Address | Email hidden; Javascript is required. |
| Unique Identifier | 16170600332 |
| 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 | 5 |
| From | 05/25/2023 |
| To | 06/08/2023 |
| Days | 14 |
| Payment Details | |
| Payment Amount | $1,200.00 |
| Receipt Amount | $1,157.00 |
| Receipt Date | 05/25/2023 |
| Comments | hotel stay at Super 8 departure date is 06/07/23 |
| Receipt | 27236-Samaniego.pdf |
| Staff Name | Gloria Jimenez |
| Case Manager | BP |
| Case Worker Email | Email hidden; Javascript is required. |
| Verifier Name | Gloria Jimenez |
| Verifier Signature | |
| Date Verified | 05/30/2023 |
