| Payment ID | 3176 |
|---|---|
| Date Created | 06/28/22 10:32 am |
| Created By | Gloria Jimenez |
| Service Request | |
| Application ID | 2693 |
| Authorization Number | |
| Applicant Information | |
| Name | Janice Mongiovi |
| Agency Name | Homeless Coalition |
| Agency Code | 220213 |
| Agency | Homeless Coalition |
| Agency Email Address | Email hidden; Javascript is required. |
| Unique Identifier | 16171100253 |
| Payment Type | Short-Term Hotel/Motel Stays |
| Payment Details | |
| Receipt Amount | $1,742.17 |
| Receipt Date | 06/27/2022 |
| Comments | hotel stay Woodspring Suites 6/27/22 through 7/27/22 |
| Staff Name | Gloria Jimenez |
| Case Manager | AL |
| Verifier Name | Gloria Jimenez |
| Verifier Signature | |
| Date Verified | 06/27/2022 |
