| Payment ID | 82414 |
|---|---|
| Date Created | 12/18/24 11:14 am |
| Created By | Gloria Jimenez |
| Service Request | 81652 |
| Application ID | 81467 |
| Authorization Number | |
| Applicant Information | |
| Name | Angela Deleon |
| Applicant Email Address | Email hidden; Javascript is required. |
| Unique Identifier | 16170403784 |
| 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 | 12/13/2024 |
| To | 12/31/2024 |
| Days | 18 |
| Payment Details | |
| Payment Amount | $1,288.30 |
| Receipt Amount | $1,357.17 |
| Receipt Date | 12/17/2024 |
| Comments | payment to Super 8 departure date is 01/01/25 |
| Receipt | 82414-Deleon.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 |
