| Payment ID | 45879 |
|---|---|
| Date Created | 11/28/23 10:02 am |
| Created By | Gloria Jimenez |
| Service Request | 45205 |
| Application ID | 40051 |
| Authorization Number | 222920 |
| Applicant Information | |
| Name | Kelsie Siegel |
| Applicant Email Address | Email hidden; Javascript is required. |
| Unique Identifier | 16171202391 |
| Payment Type | Childcare Expenses |
| Type of Service Request | Childcare |
| Provider Name | Waco Child Development Center |
| Contact | Waco Child Development Center |
| Email hidden; Javascript is required. | |
| Address | 1301 Ross Ave Waco, Texas 76706 Map It |
| Phone | (254) 759-5981 |
| Acceptable Method of Payment | Check, Money Order |
| Payment Details | |
| Payment Amount | $576.00 |
| Receipt Amount | $581.00 |
| Receipt Date | 11/27/2023 |
| Comments | childcare paid to Waco Child Development |
| Receipt | |
| Staff Name | Gloria |
| Case Manager | DJ |
| Case Worker Email | Email hidden; Javascript is required. |
| Verifier Name | Gloria Jimenez |
| Verifier Signature | |
| Date Verified | 11/28/2023 |
