| Payment ID | 82933 |
|---|---|
| Date Created | 12/20/24 9:59 am |
| Created By | Gloria Jimenez |
| Service Request | 82532 |
| Application ID | 75020 |
| Authorization Number | 224473 |
| Applicant Information | |
| Name | Brittany Benson |
| Applicant Email Address | Email hidden; Javascript is required. |
| Unique Identifier | 16170603638 |
| 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 | 12/19/2024 |
| To | 12/31/2024 |
| Days | 12 |
| Payment Details | |
| Payment Amount | $860.52 |
| Receipt Amount | $928.59 |
| Receipt Date | 12/19/2024 |
| Comments | hotel paid through 01/01/25 |
| Receipt | 82933-Benson.pdf |
| Staff Name | Gloria Jimenez |
| Case Manager | DJ |
| Case Worker Email | Email hidden; Javascript is required. |
| Verifier Name | Gloria Jimenez |
| Verifier Signature | |
| Date Verified | 12/20/2024 |
