| Payment ID | 84085 |
|---|---|
| Date Created | 12/31/24 4:26 pm |
| Created By | Gloria Jimenez |
| Service Request | 83086 |
| Application ID | 82961 |
| Authorization Number | 224503 |
| Applicant Information | |
| Name | Tonya Burns |
| Applicant Email Address | Email hidden; Javascript is required. |
| Unique Identifier | 14764203882 |
| Payment Type | Short-Term Hotel/Motel Stays |
| Type of Service Request | Hotel Stay |
| Location | OYO Hotel Groesbeck |
| Location Contact Name | OYO Hotel Groesbeck |
| Location Email Address | Email hidden; Javascript is required. |
| Start Day | Monday |
| Guests | 1 |
| From | 12/20/2024 |
| To | 12/31/2024 |
| Days | 11 |
| Payment Details | |
| Payment Amount | $574.00 |
| Receipt Amount | $560.45 |
| Receipt Date | 12/31/2024 |
| Comments | HOTEL STAY AT OYO |
| Receipt | 84085-Burns.pdf |
| Staff Name | Gloria Jimenez |
| Case Manager | BP |
| Case Worker Email | Email hidden; Javascript is required. |
| Verifier Name | Gloria Jimenez |
| Verifier Signature | |
| Date Verified | 12/31/2024 |
