| Payment ID | 61684 |
|---|---|
| Date Created | 03/13/24 2:57 pm |
| Created By | Gloria Jimenez |
| Service Request | 60179 |
| Application ID | 24595 |
| Authorization Number | 223602 |
| Applicant Information | |
| Name | Riki Taylor |
| Applicant Email Address | Email hidden; Javascript is required. |
| Unique Identifier | 16170801601 |
| 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 | 3 |
| From | 03/06/2024 |
| To | 03/13/2024 |
| Days | 7 |
| Payment Details | |
| Payment Amount | $800.00 |
| Receipt Amount | $2,121.62 |
| Receipt Date | 03/08/2024 |
| Comments | hotel stay at Motel 6 departure date is 03/13/24, this payment includes more than one service request |
| Receipt | 61684-Taylor.pdf |
| Staff Name | Gloria |
| Case Manager | BJ |
| Case Worker Email | Email hidden; Javascript is required. |
| Verifier Name | Gloria Jimenez |
| Verifier Signature | |
| Date Verified | 03/13/2024 |
