| Payment ID | 42143 |
|---|---|
| Date Created | 10/16/23 2:25 pm |
| Created By | Gloria Jimenez |
| Service Request | 41756 |
| Application ID | 32317 |
| Authorization Number | 222704 |
| Applicant Information | |
| Name | Zaccheaus Dimerson |
| Applicant Email Address | Email hidden; Javascript is required. |
| Unique Identifier | 16170602025 |
| 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 | 10/16/2023 |
| To | 10/23/2023 |
| Days | 7 |
| Payment Details | |
| Payment Amount | $623.00 |
| Receipt Amount | $801.00 |
| Receipt Date | 10/12/2023 |
| Comments | hotel stay at Super 8 departure date is 10/25/23 |
| Receipt | 42143-Dimerson.pdf |
| Staff Name | Gloria |
| Case Manager | CM |
| Case Worker Email | Email hidden; Javascript is required. |
| Verifier Name | Gloria Jimenez |
| Verifier Signature | |
| Date Verified | 10/16/2023 |
