| Payment ID | 88015 |
|---|---|
| Date Created | 01/17/25 11:59 am |
| Created By | Gloria Jimenez |
| Service Request | 83016 |
| 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 | 01/01/2025 |
| To | 01/08/2025 |
| Days | 7 |
| Payment Details | |
| Payment Amount | $501.00 |
| Receipt Amount | $500.01 |
| Receipt Date | 01/06/2025 |
| Comments | hotel stay at Super 8 departure date is 01/08/25 |
| Receipt | 88015-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 | 01/17/2025 |
