| Payment ID | 28657 |
|---|---|
| Date Created | 06/08/23 2:32 pm |
| Created By | Gloria Jimenez |
| Service Request | 27575 |
| 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 | Thursday |
| Guests | 3 |
| From | 06/01/2023 |
| To | 06/07/2023 |
| Days | 6 |
| Payment Details | |
| Payment Amount | $600.00 |
| Receipt Amount | $498.68 |
| Receipt Date | 06/05/2023 |
| Comments | hotel stay at Extended Stay departure date is 06/07/23 |
| Receipt | 28657-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 | 06/08/2023 |
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