| Payment ID | 98171 |
|---|---|
| Date Created | 03/20/25 10:31 am |
| Created By | Gloria Jimenez |
| Service Request | 90689 |
| Application ID | 81016 |
| Authorization Number | 224918 |
| Applicant Information | |
| Name | Rreiona Williams |
| Applicant Email Address | Email hidden; Javascript is required. |
| Unique Identifier | 16170403763 |
| 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 | 01/31/2025 |
| To | 02/05/2025 |
| Days | 5 |
| Payment Details | |
| Payment Amount | $300.00 |
| Receipt Amount | $142.86 |
| Receipt Date | 03/17/2025 |
| Comments | hotel stay at Super 8 |
| Receipt | |
| Staff Name | Gloria Jimenez |
| Case Manager | BP |
| Case Worker Email | Email hidden; Javascript is required. |
| Verifier Name | Gloria Jimenez |
| Verifier Signature | |
| Date Verified | 03/20/2025 |
