| Payment ID | 82411 |
|---|---|
| Date Created | 12/18/24 11:07 am |
| Created By | Gloria Jimenez |
| Service Request | 81848 |
| Application ID | 37646 |
| Authorization Number | 224444 |
| Applicant Information | |
| Name | Chelsea Campos |
| Applicant Email Address | Email hidden; Javascript is required. |
| Unique Identifier | 16171002265 |
| 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 | $1,073.57 |
| Receipt Amount | $1,142.88 |
| Receipt Date | 12/17/2024 |
| Comments | payment to Super 8 departure date is 01/01/25 |
| Receipt | 82411-Campos.pdf |
| Staff Name | Gloria Jimenez |
| Case Manager | DG |
| Case Worker Email | Email hidden; Javascript is required. |
| Verifier Name | Gloria Jimenez |
| Verifier Signature | |
| Date Verified | 12/18/2024 |
