| Payment ID | 3065 |
|---|---|
| Date Created | 06/27/22 9:22 am |
| Created By | Gloria Jimenez |
| Service Request | |
| Application ID | 570 |
| Authorization Number | |
| Applicant Information | |
| Name | Dwayne Martin |
| Agency Name | Homeless Coalition |
| Agency Code | 220213 |
| Agency | Homeless Coalition |
| Agency Email Address | Email hidden; Javascript is required. |
| Unique Identifier | 16170100081 |
| Payment Type | Homelessness |
| Payment Details | |
| Receipt Amount | $264.07 |
| Receipt Date | 05/26/2022 |
| Comments | Walmart shopping |
| Receipt | 3065-Martin.pdf |
| Staff Name | Gloria Jimenez |
| Case Manager | YS |
| Verifier Name | Gloria Jimenez |
| Verifier Signature | |
| Date Verified | 05/26/2022 |
