| Payment ID | 40607 |
|---|---|
| Date Created | 09/27/23 11:11 am |
| Created By | Gloria Jimenez |
| Service Request | 40059 |
| Application ID | 34372 |
| Authorization Number | |
| 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 | 09/20/2023 |
| To | 09/27/2023 |
| Days | 7 |
| Payment Details | |
| Payment Amount | $800.00 |
| Receipt Amount | $1,869.00 |
| Receipt Date | 09/27/2023 |
| Comments | hotel stay at Super 8 paid through 09/27/23. payment includes more than one service request |
| Receipt | 40607-Williams.pdf |
| Staff Name | Gloria |
| Case Manager | BJ |
| Case Worker Email | Email hidden; Javascript is required. |
| Verifier Name | Gloria Jimenez |
| Verifier Signature | |
| Date Verified | 09/27/2023 |
