| Payment ID | 2915 |
|---|---|
| Date Created | 06/23/22 3:15 pm |
| Created By | Gloria Jimenez |
| Service Request | |
| Application ID | 1791 |
| Authorization Number | |
| Applicant Information | |
| Name | Jessica Baker |
| Agency Name | Homeless Coalition |
| Agency Code | 220213 |
| Agency | Homeless Coalition |
| Agency Email Address | Email hidden; Javascript is required. |
| Unique Identifier | 16170400196 |
| Payment Type | Homelessness |
| Payment Details | |
| Receipt Amount | $249.03 |
| Receipt Date | 06/17/2022 |
| Comments | walmart shopping |
| Staff Name | Gloria Jimenez |
| Case Manager | DG |
| Verifier Name | Gloria Jimenez |
| Verifier Signature | |
| Date Verified | 06/23/2022 |
