| Payment ID | 81843 |
|---|---|
| Date Created | 12/16/24 12:55 pm |
| Created By | Gloria Jimenez |
| Service Request | 81424 |
| Application ID | 12762 |
| Authorization Number | 224435 |
| Applicant Information | |
| Name | Kimberlee Mabry |
| Applicant Email Address | Email hidden; Javascript is required. |
| Unique Identifier | 16171000997 |
| 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 | 12/16/2024 |
| To | 12/31/2024 |
| Days | 15 |
| Payment Details | |
| Payment Amount | $1,000.00 |
| Receipt Amount | $1,428.60 |
| Receipt Date | 12/13/2024 |
| Comments | payment to Super 8 through 12/31/24 |
| Receipt | 81843-Mabry.pdf |
| Staff Name | Gloria Jimenez |
| Case Manager | LRE |
| Case Worker Email | Email hidden; Javascript is required. |
| Verifier Name | Gloria Jimenez |
| Verifier Signature | |
| Date Verified | 12/16/2024 |
