| Payment ID | 49096 |
|---|---|
| Date Created | 12/18/23 5:36 pm |
| Created By | Gloria Jimenez |
| Service Request | 46548 |
| Application ID | 10211 |
| Authorization Number | 223024 |
| Applicant Information | |
| Name | Tamara Carpenter |
| Applicant Email Address | Email hidden; Javascript is required. |
| Unique Identifier | 16170400848 |
| 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 | 12/06/2023 |
| To | 01/03/2024 |
| Days | 28 |
| Payment Details | |
| Payment Amount | $2,800.00 |
| Receipt Amount | $2,492.00 |
| Receipt Date | 12/18/2023 |
| Comments | hotel stay at Super 8 departure date is 01/03/24 |
| Receipt | 49096-Carpenter.pdf |
| Staff Name | Gloria |
| Case Manager | LRE |
| Case Worker Email | Email hidden; Javascript is required. |
| Verifier Name | Gloria Jimenez |
| Verifier Signature | |
| Date Verified | 12/18/2023 |
