| Payment ID | 52670 |
|---|---|
| Date Created | 01/18/24 10:22 am |
| Created By | Gloria Jimenez |
| Service Request | 52248 |
| Application ID | 47421 |
| Authorization Number | 223210 |
| Applicant Information | |
| Name | Clifford Stanley |
| Applicant Email Address | Email hidden; Javascript is required. |
| Unique Identifier | 16170102699 |
| Payment Type | Short-Term Hotel/Motel Stays |
| Type of Service Request | Hotel Stay |
| Location | Motel 6 Waco |
| Location Contact Name | Laurel |
| Location Email Address | Email hidden; Javascript is required. |
| Start Day | Monday |
| Guests | 1 |
| From | 01/17/2024 |
| To | 01/24/2024 |
| Days | 7 |
| Payment Details | |
| Payment Amount | $800.00 |
| Receipt Amount | $513.98 |
| Receipt Date | 01/17/2024 |
| Comments | hotel stay at Motel 6 departure date is 01/24/24 |
| Receipt | 52670-Stanley.pdf |
| Staff Name | Gloria |
| Case Manager | BJ |
| Case Worker Email | Email hidden; Javascript is required. |
| Verifier Name | Gloria Jimenez |
| Verifier Signature | |
| Date Verified | 01/18/2024 |
