| Payment ID | 49141 |
|---|---|
| Date Created | 12/20/23 10:19 am |
| Created By | Gloria Jimenez |
| Service Request | 44892 |
| Application ID | 38304 |
| Authorization Number | 222915 |
| Applicant Information | |
| Name | Angela Espinosa |
| Applicant Email Address | Email hidden; Javascript is required. |
| Unique Identifier | 16170602291 |
| 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 | Thursday |
| Guests | 5 |
| From | 11/17/2023 |
| To | 11/22/2023 |
| Days | 6 |
| Payment Details | |
| Payment Amount | $700.00 |
| Receipt Amount | $1,246.00 |
| Receipt Date | 12/13/2023 |
| Comments | hotel stay at Super 8 |
| Receipt | 49141-Espinosa.pdf |
| Staff Name | Gloria |
| Case Manager | LRE |
| Case Worker Email | Email hidden; Javascript is required. |
| Verifier Name | Gloria Jimenez |
| Verifier Signature | |
| Date Verified | 12/20/2023 |
