| Payment ID | 65184 |
|---|---|
| Date Created | 04/30/24 1:41 pm |
| Created By | Gloria Jimenez |
| Service Request | 65175 |
| Application ID | 47657 |
| Authorization Number | 223789 |
| Applicant Information | |
| Name | Sara Crummer Gonzales |
| Applicant Email Address | Email hidden; Javascript is required. |
| Unique Identifier | 16165702707 |
| 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 | 4 |
| From | 03/12/2024 |
| To | 03/13/2024 |
| Days | 1 |
| Payment Details | |
| Payment Amount | $89.00 |
| Receipt Amount | $89.00 |
| Receipt Date | 04/12/2024 |
| Comments | hotel stay at Super 8 |
| Receipt | 65184-Crummer-Gonzales.pdf |
| Staff Name | Gloria |
| Case Manager | BJ |
| Case Worker Email | Email hidden; Javascript is required. |
| Verifier Name | Gloria Jimenez |
| Verifier Signature | |
| Date Verified | 04/30/2024 |
