| Payment ID | 83371 |
|---|---|
| Date Created | 12/21/24 6:41 pm |
| Created By | Gloria Jimenez |
| Service Request | 83131 |
| Application ID | 74858 |
| Authorization Number | 224499 |
| Applicant Information | |
| Name | Edna Grady |
| Applicant Email Address | Email hidden; Javascript is required. |
| Unique Identifier | 16170603630 |
| 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 | 12/20/2024 |
| To | 01/01/2025 |
| Days | 12 |
| Payment Details | |
| Payment Amount | $859.00 |
| Receipt Amount | $857.16 |
| Receipt Date | 12/20/2024 |
| Comments | payment to hotel |
| Receipt | 83371-Grady.pdf |
| Staff Name | Gloria Jimenez |
| Case Manager | DG |
| Case Worker Email | Email hidden; Javascript is required. |
| Verifier Name | Gloria Jimenez |
| Verifier Signature | |
| Date Verified | 12/21/2024 |
