| Payment ID | 120459 |
|---|---|
| Date Created | 09/15/25 9:42 am |
| Created By | Gloria Jimenez |
| Service Request | 118993 |
| Application ID | 83665 |
| Authorization Number | 226976 |
| Applicant Information | |
| Name | Asia Moseley |
| Applicant Email Address | Email hidden; Javascript is required. |
| Unique Identifier | 16170804049 |
| Payment Type | Childcare Expenses |
| Type of Service Request | Childcare |
| Provider Name | YMCA |
| Contact | YMCA |
| Email hidden; Javascript is required. | |
| Address | 1812 N Mays St Round Rock, Texas 78664 Map It |
| Phone | (512) 615-7820 |
| Acceptable Method of Payment | Check |
| Payment Details | |
| Payment Amount | $520.00 |
| Receipt Amount | $525.00 |
| Receipt Date | 09/12/2025 |
| Comments | childcare paid to YMCA in the amount of $520.00 plus a bank fee of $5.00 for cashiers check |
| Receipt | |
| Staff Name | Gloria Jimenez |
| Case Manager | CM |
| Case Worker Email | Email hidden; Javascript is required. |
| Verifier Name | Gloria Jimenez |
| Verifier Signature | |
| Date Verified | 09/15/2025 |
