| Payment ID | 37382 |
|---|---|
| Date Created | 08/16/23 11:50 am |
| Created By | Gloria Jimenez |
| Service Request | 35628 |
| Application ID | 26354 |
| Authorization Number | 222376 |
| Applicant Information | |
| Name | LaTonia Hughes |
| Applicant Email Address | Email hidden; Javascript is required. |
| Unique Identifier | 16171001696 |
| 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 | Monday |
| Guests | 1 |
| From | 08/02/2023 |
| To | 08/09/2023 |
| Days | 7 |
| Payment Details | |
| Payment Amount | $623.00 |
| Receipt Amount | $1,691.00 |
| Receipt Date | 08/03/2023 |
| Comments | hotel stay from 07/25/23 departure 08/09/23 |
| 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 |
