| Payment ID | 68404 |
|---|---|
| Date Created | 06/10/24 11:44 am |
| Created By | Gloria Jimenez |
| Service Request | 68043 |
| Application ID | 64555 |
| Authorization Number | 223905 |
| Applicant Information | |
| Name | Elizabeth Kiser |
| Applicant Email Address | Email hidden; Javascript is required. |
| Unique Identifier | 16170403216 |
| 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 | 1 |
| From | 06/05/2024 |
| To | 06/12/2024 |
| Days | 7 |
| Payment Details | |
| Payment Amount | $500.00 |
| Receipt Amount | $500.01 |
| Receipt Date | 06/05/2024 |
| Comments | hotel stay at Super 8 departure date is 06/12/24 |
| Receipt | 68404-Kiser.pdf |
| Staff Name | Gloria |
| Case Manager | BJ |
| Case Worker Email | Email hidden; Javascript is required. |
| Verifier Name | Gloria Jimenez |
| Verifier Signature | |
| Date Verified | 06/10/2024 |
