| Payment ID | 90750 |
|---|---|
| Date Created | 01/31/25 2:31 pm |
| Created By | Gloria Jimenez |
| Service Request | 83010 |
| Application ID | 81141 |
| Authorization Number | 224496 |
| Applicant Information | |
| Name | Dulce Paloblanco |
| Applicant Email Address | Email hidden; Javascript is required. |
| Unique Identifier | 16170703767 |
| 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 | 12/31/2024 |
| To | 01/01/2025 |
| Days | 1 |
| Payment Details | |
| Payment Amount | $71.57 |
| Receipt Amount | $142.86 |
| Receipt Date | 01/30/2025 |
| Comments | hotel payment for 2 nights |
| Receipt | 90750-Paloblanco.pdf |
| Staff Name | Gloria Jimenez |
| Case Manager | DG |
| Case Worker Email | Email hidden; Javascript is required. |
| Verifier Name | Gloria Jimenez |
| Verifier Signature | |
| Date Verified | 01/31/2025 |
