| Payment ID | 11169 |
|---|---|
| Date Created | 11/07/22 12:23 pm |
| Created By | Gloria Jimenez |
| Service Request | |
| Application ID | 2756 |
| Authorization Number | |
| Applicant Information | |
| Name | Byron Allen |
| Agency Name | Homeless Coalition |
| Agency Code | 220213 |
| Agency | Homeless Coalition |
| Agency Email Address | Email hidden; Javascript is required. |
| Applicant Email Address | Email hidden; Javascript is required. |
| Unique Identifier | 16171100260 |
| Payment Type | Short-Term Hotel/Motel Stays |
| Payment Details | |
| Receipt Amount | $285.00 |
| Receipt Date | 11/07/2022 |
| Comments | hotel extension departure date is 11/14/2022 |
| Receipt | 16171100260-285.00-07-11-2022.pdf |
| Staff Name | Gloria Jimenez |
| Case Manager | DJ |
| Verifier Name | Gloria Jimenez |
| Verifier Signature | |
| Date Verified | 11/07/2022 |
