| Payment ID | 86042 |
|---|---|
| Date Created | 01/09/25 1:04 pm |
| Created By | Gloria Jimenez |
| Service Request | 85002 |
| Application ID | 61612 |
| Authorization Number | 224547 |
| Applicant Information | |
| Name | Tameika Randle |
| Applicant Email Address | Email hidden; Javascript is required. |
| Unique Identifier | 16165703087 |
| Payment Type | Short-Term Hotel/Motel Stays |
| Type of Service Request | Hotel Stay |
| Location | Motel 6 Waco |
| Location Contact Name | Laurel |
| Location Email Address | Email hidden; Javascript is required. |
| Start Day | Monday |
| Guests | 1 |
| From | 01/07/2025 |
| To | 01/14/2025 |
| Days | 7 |
| Payment Details | |
| Payment Amount | $500.00 |
| Receipt Amount | $1,035.16 |
| Receipt Date | 01/08/2025 |
| Comments | hotel stay at Motel 6 departure date is 01/15/25 |
| Receipt | 86042-Randle.pdf |
| Staff Name | Gloria Jimenez |
| Case Manager | LRE |
| Case Worker Email | Email hidden; Javascript is required. |
| Verifier Name | Gloria Jimenez |
| Verifier Signature | |
| Date Verified | 01/09/2025 |
