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Payment ID45927
Date Created11/28/23 11:27 am
Created ByGloria Jimenez
Service Request44637
Application ID36791
Authorization Number222897
Applicant Information
NameJennifer Jefferson
Applicant Email AddressEmail hidden; Javascript is required.
Unique Identifier16170802227
Payment TypeShort-Term Hotel/Motel Stays
Type of Service RequestHotel Stay
LocationMotel 6 Waco
Location Contact NameLaurel
Location Email AddressEmail hidden; Javascript is required.
Start DayMonday
Guests2
From11/15/2023
To11/22/2023
Days7
Payment Details
Payment Amount$550.00
Receipt Amount$530.08
Receipt Date11/27/2023
Comments

hotel stay at Motel 6 departure date is 11/29/23

Receipt45927-Jefferson.pdf
Staff NameGloria
Case ManagerDJ
Case Worker EmailEmail hidden; Javascript is required.
Verifier NameGloria Jimenez
Verifier Signature
Date Verified11/28/2023