| Payment ID | 93209 |
|---|---|
| Date Created | 02/13/25 4:54 pm |
| Created By | Gloria Jimenez |
| Service Request | 88399 |
| Application ID | 80416 |
| Authorization Number | 224732 |
| Applicant Information | |
| Name | Corey Coleman |
| Applicant Email Address | Email hidden; Javascript is required. |
| Unique Identifier | 16170603741 |
| 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 | 01/22/2025 |
| To | 01/29/2025 |
| Days | -19 |
| Payment Details | |
| Payment Amount | $501.00 |
| Receipt Amount | $500.01 |
| Receipt Date | 02/13/2025 |
| Comments | hotel stay at Super 8 departed 01/29/25 |
| Receipt | |
| Staff Name | Gloria Jimenez |
| Case Manager | DL |
| Case Worker Email | Email hidden; Javascript is required. |
| Verifier Name | Gloria Jimenez |
| Verifier Signature | |
| Date Verified | 02/13/2025 |
