| Payment ID | 49027 |
|---|---|
| Date Created | 12/18/23 1:04 pm |
| Created By | Gloria Jimenez |
| Service Request | 47945 |
| Application ID | 43645 |
| Authorization Number | 223062 |
| Applicant Information | |
| Name | Edward Simmons |
| Applicant Email Address | Email hidden; Javascript is required. |
| Unique Identifier | 07463202550 |
| 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 | 12/05/2023 |
| To | 12/12/2023 |
| Days | 7 |
| Payment Details | |
| Payment Amount | $800.00 |
| Receipt Amount | $1,246.00 |
| Receipt Date | 12/13/2023 |
| Comments | HOTEL STAY AT SUPER 8 DEPARTURE DATE 12/20/23 |
| Receipt | 49027-Simmons.pdf |
| Staff Name | Gloria |
| Case Manager | BP |
| Case Worker Email | Email hidden; Javascript is required. |
| Verifier Name | Gloria Jimenez |
| Verifier Signature | |
| Date Verified | 12/18/2023 |
