| Payment ID | 99571 |
|---|---|
| Date Created | 03/31/25 11:32 am |
| Created By | Gloria Jimenez |
| Service Request | 97918 |
| Application ID | 87637 |
| Authorization Number | 225456 |
| Applicant Information | |
| Name | Lanessa Najar-conway |
| Applicant Email Address | Email hidden; Javascript is required. |
| Unique Identifier | 16171004279 |
| 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 | 2 |
| From | 03/19/2025 |
| To | 03/21/2025 |
| Days | 2 |
| Payment Details | |
| Payment Amount | $150.00 |
| Receipt Amount | $500.01 |
| Receipt Date | 03/19/2025 |
| Comments | hotel stay at Super 8 departure date is 03/26/25 |
| Receipt | |
| Staff Name | Gloria Jimenez |
| Case Manager | BP |
| Case Worker Email | Email hidden; Javascript is required. |
| Verifier Name | Gloria Jimenez |
| Verifier Signature | |
| Date Verified | 03/31/2025 |
