| Payment ID | 88645 |
|---|---|
| Date Created | 01/21/25 3:30 pm |
| Created By | Gloria Jimenez |
| Service Request | 87802 |
| Application ID | 73388 |
| Authorization Number | 224695 |
| Applicant Information | |
| Name | Bethaney Hardin |
| Applicant Email Address | Email hidden; Javascript is required. |
| Unique Identifier | 16163303574 |
| 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 | 5 |
| From | 01/16/2025 |
| To | 01/22/2025 |
| Days | 6 |
| Payment Details | |
| Payment Amount | $623.00 |
| Receipt Amount | $428.58 |
| Receipt Date | 01/20/2025 |
| Comments | 1 extension |
| Receipt | 88645-Hardin.pdf |
| Staff Name | Gloria Jimenez |
| Case Manager | CM |
| Case Worker Email | Email hidden; Javascript is required. |
| Verifier Name | Gloria Jimenez |
| Verifier Signature | |
| Date Verified | 01/21/2025 |
