| Payment ID | 47286 |
|---|---|
| Date Created | 12/06/23 10:03 am |
| Created By | Gloria Jimenez |
| Service Request | 45923 |
| Application ID | 31871 |
| Authorization Number | 222984 |
| Applicant Information | |
| Name | Demetrice Wilson |
| Applicant Email Address | Email hidden; Javascript is required. |
| Unique Identifier | 16170801997 |
| 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 | 11/28/2023 |
| To | 12/13/2023 |
| Days | 15 |
| Payment Details | |
| Payment Amount | $1,280.00 |
| Receipt Amount | $534.00 |
| Receipt Date | 12/01/2023 |
| Comments | hotel stay at Super 8 departure date is 12/06/2023 |
| Receipt | 47286-Wilson.pdf |
| Staff Name | Gloria |
| Case Manager | DL |
| Case Worker Email | Email hidden; Javascript is required. |
| Verifier Name | Gloria Jimenez |
| Verifier Signature | |
| Date Verified | 12/06/2023 |
