| Payment ID | 58364 |
|---|---|
| Date Created | 02/13/24 9:15 am |
| Created By | Gloria Jimenez |
| Service Request | 54529 |
| Application ID | 49390 |
| Authorization Number | 223320 |
| Applicant Information | |
| Name | Santana Smith |
| Applicant Email Address | Email hidden; Javascript is required. |
| Unique Identifier | 16171002789 |
| 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 | Thursday |
| Guests | 2 |
| From | 02/01/2024 |
| To | 02/07/2024 |
| Days | 6 |
| Payment Details | |
| Payment Amount | $623.00 |
| Receipt Amount | $456.49 |
| Receipt Date | 02/12/2024 |
| Comments | hotel stay at Motel 6 departure date is 02/07/24 |
| Receipt | 58364-Smith.pdf |
| Staff Name | Gloria |
| Case Manager | CM |
| Case Worker Email | Email hidden; Javascript is required. |
| Verifier Name | Gloria Jimenez |
| Verifier Signature | |
| Date Verified | 02/13/2024 |
