| Payment ID | 37907 |
|---|---|
| Date Created | 08/21/23 5:59 pm |
| Created By | Gloria Jimenez |
| Service Request | 37268 |
| Application ID | 34372 |
| Authorization Number | 222469 |
| Applicant Information | |
| Name | Summer Williams |
| Applicant Email Address | Email hidden; Javascript is required. |
| Unique Identifier | 16170502100 |
| 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 | 2 |
| From | 08/16/2023 |
| To | 08/23/2023 |
| Days | 7 |
| Payment Details | |
| Payment Amount | $800.00 |
| Receipt Amount | $2,492.00 |
| Receipt Date | 08/21/2023 |
| Comments | hotel stay at Super 8 from 08/02/23 departing 08/30/23, fire victim |
| Receipt | 37907-Williams.pdf |
| Staff Name | Gloria Jimenez |
| Case Manager | BJ |
| Case Worker Email | Email hidden; Javascript is required. |
| Verifier Name | Gloria Jimenez |
| Verifier Signature | |
| Date Verified | 08/21/2023 |
