| Payment ID | 52312 |
|---|---|
| Date Created | 01/16/24 3:33 pm |
| Created By | Gloria Jimenez |
| Service Request | 52156 |
| Application ID | 16564 |
| Authorization Number | 223198 |
| Applicant Information | |
| Name | Jami Monroy Santiago |
| Applicant Email Address | Email hidden; Javascript is required. |
| Unique Identifier | 14766701235 |
| 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 | 3 |
| From | 01/17/2024 |
| To | 01/24/2024 |
| Days | 7 |
| Payment Details | |
| Payment Amount | $800.00 |
| Receipt Amount | $1,157.00 |
| Receipt Date | 01/16/2024 |
| Comments | hotel stay at Super 8 departure date is 01/24/24, this payment includes more than one service request |
| Receipt | 52312-Monroy-Santiago.pdf |
| Staff Name | Gloria |
| Case Manager | BP |
| Case Worker Email | Email hidden; Javascript is required. |
| Verifier Name | Gloria Jimenez |
| Verifier Signature | |
| Date Verified | 01/16/2024 |
