| Payment ID | 51858 |
|---|---|
| Date Created | 01/11/24 2:33 pm |
| Created By | Gloria Jimenez |
| Service Request | 51405 |
| Application ID | 46182 |
| Authorization Number | 223175 |
| Applicant Information | |
| Name | Jennifer Baker |
| Applicant Email Address | Email hidden; Javascript is required. |
| Unique Identifier | 16171002663 |
| 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 | 3 |
| From | 01/10/2024 |
| To | 01/17/2024 |
| Days | 8 |
| Payment Details | |
| Payment Amount | $640.00 |
| Receipt Amount | $2,818.00 |
| Receipt Date | 01/10/2024 |
| Comments | hotel stay at Super 8 departure date is 01/17/23, this payment includes more than one service request |
| Receipt | 51858-Baker.pdf |
| Staff Name | Gloria |
| Case Manager | DL |
| Case Worker Email | Email hidden; Javascript is required. |
| Verifier Name | Gloria Jimenez |
| Verifier Signature | |
| Date Verified | 01/11/2024 |
