| Payment ID | 95755 |
|---|---|
| Date Created | 03/01/25 11:47 am |
| Created By | Gloria Jimenez |
| Service Request | 95153 |
| Application ID | 9049 |
| Authorization Number | 225230 |
| Applicant Information | |
| Name | Alexis Kirven |
| Applicant Email Address | Email hidden; Javascript is required. |
| Unique Identifier | 16170500737 |
| 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 | 3 |
| From | 02/26/2025 |
| To | 03/05/2025 |
| Days | 7 |
| Payment Details | |
| Payment Amount | $502.00 |
| Receipt Amount | $142.86 |
| Receipt Date | 02/28/2025 |
| Comments | hotel stay |
| Receipt | |
| Staff Name | Gloria Jimenez |
| Case Manager | DJ |
| Case Worker Email | Email hidden; Javascript is required. |
| Verifier Name | Gloria Jimenez |
| Verifier Signature | |
| Date Verified | 03/01/2025 |
