| Payment ID | 41847 |
|---|---|
| Date Created | 10/12/23 4:37 pm |
| Created By | Gloria Jimenez |
| Service Request | 36724 |
| Application ID | 21415 |
| Authorization Number | 222440 |
| Applicant Information | |
| Name | Doureycia Silmon |
| Applicant Email Address | Email hidden; Javascript is required. |
| Unique Identifier | 16170801472 |
| 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 | 4 |
| From | 08/09/2023 |
| To | 08/16/2023 |
| Days | 8 |
| Payment Details | |
| Payment Amount | $623.00 |
| Receipt Amount | $1,068.00 |
| Receipt Date | 10/11/2023 |
| Comments | payment to Super 8 departure date is 08/21/23, this payment includes more than one service request |
| Receipt | 41847-Silmon.pdf |
| Staff Name | Gloria |
| Case Manager | DG |
| Case Worker Email | Email hidden; Javascript is required. |
| Verifier Name | Gloria Jimenez |
| Verifier Signature | |
| Date Verified | 10/12/2023 |
