| Payment ID | 12133 |
|---|---|
| Date Created | 11/22/22 10:09 am |
| Created By | Gloria Jimenez |
| Service Request | |
| Application ID | 5378 |
| Authorization Number | |
| Applicant Information | |
| Name | Christopher Cline |
| 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 | 16171100496 |
| Payment Type | Short-Term Hotel/Motel Stays |
| Payment Details | |
| Receipt Amount | $712.01 |
| Receipt Date | 11/21/2022 |
| Comments | hotel stay at Super 8 departure date is 11/21/2022 |
| Receipt | 21-11-2022Cline712.01.pdf |
| Staff Name | Gloria Jimenez |
| Case Manager | LRE |
| Verifier Name | Gloria Jimenez |
| Verifier Signature | |
| Date Verified | 11/22/2022 |
