| Payment ID | 29527 |
|---|---|
| Date Created | 06/15/23 1:23 pm |
| Created By | Gloria Jimenez |
| Service Request | 27204 |
| Application ID | 20129 |
| Authorization Number | |
| Applicant Information | |
| Name | Jarayvia Davis |
| Applicant Email Address | Email hidden; Javascript is required. |
| Unique Identifier | 16171201409 |
| 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 | 05/31/2023 |
| To | 06/07/2023 |
| Days | 7 |
| Payment Details | |
| Payment Amount | $601.37 |
| Receipt Amount | $979.67 |
| Receipt Date | 06/14/2023 |
| Comments | hotel stay at Motel 6 from 05/31/23 departure date is 06/14/23 |
| Receipt | 29527-Davis.pdf |
| Staff Name | Gloria Jimenez |
| Case Manager | DG |
| Case Worker Email | Email hidden; Javascript is required. |
| Verifier Name | Gloria Jimenez |
| Verifier Signature | |
| Date Verified | 06/15/2023 |
