| Payment ID | 111892 |
|---|---|
| Date Created | 06/19/25 10:06 am |
| Created By | Gloria Jimenez |
| Service Request | 110264 |
| Application ID | 30987 |
| Authorization Number | 226321 |
| Applicant Information | |
| Name | Shatea Randolph |
| Applicant Email Address | Email hidden; Javascript is required. |
| Unique Identifier | 16170401960 |
| 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 | 5 |
| From | 06/11/2025 |
| To | 06/18/2025 |
| Days | 7 |
| Payment Details | |
| Payment Amount | $500.00 |
| Receipt Amount | $1,285.74 |
| Receipt Date | 06/16/2025 |
| Comments | hotel stay at Super 8 departure date is 06/18/25, this payment includes more than one service request |
| Receipt | |
| Staff Name | Gloria Jimenez |
| Case Manager | LRE |
| Case Worker Email | Email hidden; Javascript is required. |
| Verifier Name | Gloria Jimenez |
| Verifier Signature | |
| Date Verified | 06/19/2025 |
Housing Stability Services Program
Available 24/7
Housing Stability Services Program
Available 24/7
Funded by Texas Department of Housing and Community Affairs
Funded by Texas Department of Housing and Community Affairs