| Payment ID | 42035 |
|---|---|
| Date Created | 10/16/23 9:39 am |
| Created By | Gloria Jimenez |
| Service Request | 34914 |
| Application ID | 26936 |
| Authorization Number | 222339 |
| Applicant Information | |
| Name | Janae Scott |
| Applicant Email Address | Email hidden; Javascript is required. |
| Unique Identifier | 16171001733 |
| 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 | 2 |
| From | 07/28/2023 |
| To | 08/04/2023 |
| Days | 7 |
| Payment Details | |
| Payment Amount | $700.00 |
| Receipt Amount | $3,115.00 |
| Receipt Date | 10/11/2023 |
| Comments | hotel stay at Super 8 departure date is 08/04/23. This payment includes more than one service request |
| Receipt | 42035-Scott.pdf |
| Staff Name | Gloria |
| Case Manager | LRE |
| Case Worker Email | Email hidden; Javascript is required. |
| Verifier Name | Gloria Jimenez |
| Verifier Signature | |
| Date Verified | 10/16/2023 |
