| Payment ID | 47466 |
|---|---|
| Date Created | 12/06/23 2:15 pm |
| Created By | Gloria Jimenez |
| Service Request | 46185 |
| Application ID | 43324 |
| Authorization Number | 223009 |
| Applicant Information | |
| Name | Penelope Sampson |
| Applicant Email Address | Email hidden; Javascript is required. |
| Unique Identifier | 16171202524 |
| Payment Type | Security Deposits, Pet Deposits and App Fees |
| Type of Service Request | Application Fees |
| Provider Name | Dripping Springs Senior Village |
| Contact Name | Regina Horton |
| Contact Email | Email hidden; Javascript is required. |
| Address | 2405 JJ Flewellen Rd Waco, Texas 76704 Map It |
| Phone | (254) 412-2262 |
| Acceptable Method of Payment | Cashier's check / money order |
| Payment Details | |
| Payment Amount | $35.00 |
| Bank Fees | No |
| Receipt Amount | $35.00 |
| Receipt Date | 12/05/2023 |
| Comments | app fee paid |
| Receipt | |
| Staff Name | Gloria |
| Case Manager | LRE |
| Case Worker Email | Email hidden; Javascript is required. |
| Verifier Name | Gloria Jimenez |
| Verifier Signature | |
| Date Verified | 12/06/2023 |
