| Payment ID | 15221 |
|---|---|
| Date Created | 01/10/23 11:32 am |
| Created By | Gloria Jimenez |
| Service Request | |
| Application ID | 12491 |
| Authorization Number | |
| Applicant Information | |
| Name | Ivy Pricer |
| 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 | 16171000986 |
| Payment Type | Short-Term Hotel/Motel Stays |
| Payment Details | |
| Payment Amount | -$98.73 |
| Bank Fees | No |
| Receipt Amount | -$98.73 |
| Receipt Date | 01/09/2023 |
| Comments | refund from Super 8 |
| Receipt | 09-01-2023Pricer-98.73.pdf |
| Staff Name | Gloria Jimenez |
| Case Manager | LRE |
| Verifier Name | Gloria Jimenez |
| Verifier Signature | |
| Date Verified | 01/10/2023 |
