| Payment ID | 74638 |
|---|---|
| Date Created | 08/13/24 11:50 am |
| Created By | Gloria Jimenez |
| Service Request | 73493 |
| Application ID | 68922 |
| Authorization Number | 224300 |
| Applicant Information | |
| Name | Alexandria Carr |
| Applicant Email Address | Email hidden; Javascript is required. |
| Unique Identifier | 16170803379 |
| 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 | 5 |
| From | 08/07/2024 |
| To | 08/14/2024 |
| Days | 7 |
| Payment Details | |
| Payment Amount | $500.00 |
| Receipt Amount | $1,285.74 |
| Receipt Date | 08/11/2024 |
| Comments | Hotel stay at Super 8 departure date is 08/11/24, this payment includes more than one service request |
| Receipt | 74638-Carr.pdf |
| Staff Name | Gloria |
| Case Manager | BP |
| Case Worker Email | Email hidden; Javascript is required. |
| Verifier Name | Gloria Jimenez |
| Verifier Signature | |
| Date Verified | 08/13/2024 |
