| Payment ID | 52540 |
|---|---|
| Date Created | 01/17/24 4:21 pm |
| Created By | Gloria Jimenez |
| Service Request | 52213 |
| Application ID | 29732 |
| Authorization Number | 223209 |
| Applicant Information | |
| Name | treyvion brantley |
| Applicant Email Address | Email hidden; Javascript is required. |
| Unique Identifier | 16171001883 |
| 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 | 2 |
| From | 01/17/2024 |
| To | 01/24/2024 |
| Days | 7 |
| Payment Details | |
| Payment Amount | $700.00 |
| Receipt Amount | $623.00 |
| Receipt Date | 01/17/2024 |
| Comments | hotel stay at Super 8 departure date is 01/24/24 |
| Receipt | 52540-brantley.pdf |
| Staff Name | Gloria |
| Case Manager | LRE |
| Case Worker Email | Email hidden; Javascript is required. |
| Verifier Name | Gloria Jimenez |
| Verifier Signature | |
| Date Verified | 01/17/2024 |
