| Payment ID | 34626 |
|---|---|
| Date Created | 07/24/23 11:50 am |
| Created By | Gloria Jimenez |
| Service Request | 33380 |
| Application ID | 25054 |
| Authorization Number | 222239 |
| Applicant Information | |
| Name | Nikisha Adames |
| Applicant Email Address | Email hidden; Javascript is required. |
| Unique Identifier | 16171101628 |
| 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 | 7 |
| From | 07/18/2023 |
| To | 07/25/2023 |
| Days | 7 |
| Payment Details | |
| Payment Amount | $750.00 |
| Receipt Amount | $546.18 |
| Receipt Date | 07/21/2023 |
| Comments | hotel stay at Motel 6 departure date 07/26/23 |
| Receipt | 34626-Adames.pdf |
| Staff Name | Gloria Jimenez |
| Case Manager | LRE |
| Case Worker Email | Email hidden; Javascript is required. |
| Verifier Name | Gloria Jimenez |
| Verifier Signature | |
| Date Verified | 07/24/2023 |
