| Payment ID | 89995 |
|---|---|
| Date Created | 01/28/25 11:13 am |
| Created By | Gloria Jimenez |
| Service Request | 89705 |
| Application ID | 73074 |
| Authorization Number | |
| Applicant Information | |
| Name | Anissa Thompson |
| Applicant Email Address | Email hidden; Javascript is required. |
| Unique Identifier | 16171003554 |
| 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 | 4 |
| From | 01/15/2025 |
| To | 01/22/2025 |
| Days | 7 |
| Payment Details | |
| Payment Amount | $501.00 |
| Receipt Amount | $500.01 |
| Receipt Date | 01/15/2025 |
| Comments | HOTEL STAY AT SUPER 8 FOR ROOM 2 |
| Receipt | 89995-Thompson.pdf |
| Staff Name | Gloria Jimenez |
| Case Manager | DL |
| Case Worker Email | Email hidden; Javascript is required. |
| Verifier Name | Gloria Jimenez |
| Verifier Signature | |
| Date Verified | 01/28/2025 |
