| Payment ID | 98788 |
|---|---|
| Date Created | 03/25/25 11:33 am |
| Created By | Gloria Jimenez |
| Service Request | 95931 |
| Application ID | 82631 |
| Authorization Number | 225285 |
| Applicant Information | |
| Name | Juanita Hernandez |
| Applicant Email Address | Email hidden; Javascript is required. |
| Unique Identifier | 16170603817 |
| Payment Type | Short-Term Hotel/Motel Stays |
| Type of Service Request | Hotel Stay |
| Location | Motel 6 Waco |
| Location Contact Name | Laurel |
| Location Email Address | Email hidden; Javascript is required. |
| Start Day | Monday |
| Guests | 4 |
| From | 03/05/2025 |
| To | 03/12/2025 |
| Days | 7 |
| Payment Details | |
| Payment Amount | $500.01 |
| Receipt Amount | $1,035.16 |
| Receipt Date | 03/19/2025 |
| Comments | hotel stay at Motel 6 departing 03/12/25 this payment includes more than one service request |
| Receipt | |
| Staff Name | Gloria Jimenez |
| Case Manager | SJ |
| Case Worker Email | Email hidden; Javascript is required. |
| Verifier Name | Gloria Jimenez |
| Verifier Signature | |
| Date Verified | 03/25/2025 |
