| Payment ID | 37352 |
|---|---|
| Date Created | 08/16/23 9:44 am |
| Created By | Gloria Jimenez |
| Service Request | 30125 |
| Application ID | 6714 |
| Authorization Number | 222019 |
| Applicant Information | |
| Name | Armanda Prince |
| Applicant Email Address | Email hidden; Javascript is required. |
| Unique Identifier | 16170700591 |
| 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 | 4 |
| From | 06/22/2023 |
| To | 06/28/2023 |
| Days | 6 |
| Payment Details | |
| Payment Amount | $534.00 |
| Receipt Amount | $544.68 |
| Receipt Date | 08/03/2023 |
| Comments | hotel stay at Super 8 departure date is 06/29/23 |
| Receipt | |
| Staff Name | Gloria Jimenez |
| Case Manager | DG |
| Case Worker Email | Email hidden; Javascript is required. |
| Verifier Name | Gloria Jimenez |
| Verifier Signature | |
| Date Verified | 08/16/2023 |
