| Payment ID | 45210 |
|---|---|
| Date Created | 11/20/23 2:18 pm |
| Created By | Gloria Jimenez |
| Service Request | 44758 |
| Application ID | 40231 |
| Authorization Number | 222909 |
| Applicant Information | |
| Name | Tonia Markum |
| Applicant Email Address | Email hidden; Javascript is required. |
| Unique Identifier | 16162402403 |
| 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 | 11/15/2023 |
| To | 11/22/2023 |
| Days | 7 |
| Payment Details | |
| Payment Amount | $800.00 |
| Receipt Amount | $623.00 |
| Receipt Date | 11/17/2023 |
| Comments | hotel stay at Super 8 departure date is 11/22/23 |
| Receipt | 45210-Markum.pdf |
| Staff Name | Gloria |
| Case Manager | BP |
| Case Worker Email | Email hidden; Javascript is required. |
| Verifier Name | Gloria Jimenez |
| Verifier Signature | |
| Date Verified | 11/20/2023 |
