| Payment ID | 61663 |
|---|---|
| Date Created | 03/13/24 2:22 pm |
| Created By | Gloria Jimenez |
| Service Request | 59149 |
| Application ID | 52832 |
| Authorization Number | 223517 |
| Applicant Information | |
| Name | Dylan Smith |
| Applicant Email Address | Email hidden; Javascript is required. |
| Unique Identifier | 16171002855 |
| 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 | 02/21/2024 |
| To | 02/28/2024 |
| Days | 7 |
| Payment Details | |
| Payment Amount | $623.00 |
| Receipt Amount | $935.98 |
| Receipt Date | 03/08/2024 |
| Comments | payment to Motel 6 departure date is 02/28/24 |
| Receipt | 61663-Smith.pdf |
| Staff Name | Gloria |
| Case Manager | DG |
| Case Worker Email | Email hidden; Javascript is required. |
| Verifier Name | Gloria Jimenez |
| Verifier Signature | |
| Date Verified | 03/13/2024 |
