| Payment ID | 95118 |
|---|---|
| Date Created | 02/25/25 3:42 pm |
| Created By | Gloria Jimenez |
| Service Request | 93533 |
| Application ID | 61612 |
| Authorization Number | 225115 |
| 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 | 02/19/2025 |
| To | 02/26/2025 |
| Days | 7 |
| Payment Details | |
| Payment Amount | $500.00 |
| Receipt Amount | $517.51 |
| Receipt Date | 02/21/2025 |
| Comments | hotel stay at Motel 6 departure date is 2/26/25 |
| Receipt | |
| Staff Name | Gloria Jimenez |
| Case Manager | LRE |
| Case Worker Email | Email hidden; Javascript is required. |
| Verifier Name | Gloria Jimenez |
| Verifier Signature | |
| Date Verified | 02/25/2025 |
