| Payment ID | 82390 |
|---|---|
| Date Created | 12/18/24 10:39 am |
| Created By | Gloria Jimenez |
| Service Request | 81857 |
| Application ID | 81201 |
| Authorization Number | 224443 |
| Applicant Information | |
| Name | Brenshanda Wright |
| Applicant Email Address | Email hidden; Javascript is required. |
| Unique Identifier | 16170603769 |
| 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 | 2 |
| From | 12/16/2024 |
| To | 12/31/2024 |
| Days | 15 |
| Payment Details | |
| Payment Amount | $1,004.00 |
| Receipt Amount | $1,113.59 |
| Receipt Date | 12/17/2024 |
| Comments | payment to Super 8 departure 01/01/25 |
| Receipt | 82390-Wright.pdf |
| Staff Name | Gloria Jimenez |
| Case Manager | DL |
| Case Worker Email | Email hidden; Javascript is required. |
| Verifier Name | Gloria Jimenez |
| Verifier Signature | |
| Date Verified | 12/18/2024 |
